• Journal of Trauma and Injury
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• 제24권2호
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• pp.111-117
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• 2011

Purposes: Pancreatic injury is rare in abdominal trauma patients (3%~12%). but it could result in significant morbidity and even mortality. Early and adequate decision making are very important in the management of patients with traumatic pancreatic injury. The purpose of this study was to assess the kinds of management and outcome through the review of our experience of pancreatic injury with multiple trauma. Methods: We reviewed 17 patients with traumatic pancreas injury via electronic medical records from Jan. 2002 and April. 2011. We collected demographic findings; the type, location and grade of pancreas injury, the treatment modality, and patient's outcomes, such as complications, length of hospital stay (LOS), and mortality. Results: Total 17 patients were reviewed, and man was 13 (88%). Traffic accident was the most common cause of injury. Pancreas neck was the most common injured site, and occured in 5 patients. Ductal injury was detected in 7 cases. Eleven patients were treated by surgical procedure, and in this group, 3 patients underwent the endoscopic retrograde pancreas drainage procedure coincidently. ERPD was tried in 8 patients, and failed in 2 patients. The major complications were post-traumatic fluid collection and abscess which accounted for 70 % of all patients. The hospital stay was 35.9 days, and it was longer in patient with ductal injury ($38.0{\pm}18.56$ vs. $34.5{\pm}33.68$ days). Only one patient was died due to septic shock associated with an uncontrolled retroperitoneal abscess. Conclusion: Early diagnosis is the most important factor to apply the adequate treatment option and to manage the traumatic pancreas injury. Aggressive treatment should be considered in patients with a post-operative abscess.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.125-130
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• 2013

Purpose: This study was undertaken in order to identify the characteristics of patients diagnosed with occult an hip fracture after hip trauma. Methods: We retrospectively reviewed the medical records and radiology reports of all patients who underwent hip skeletal computed tomography (CT) for suspected hip fractures but had normal initial X-rays after hip trauma between August 2006 and January 2012. The variables evaluated included age, gender, body mass index (BMI), accident mechanism, previous fracture, independence, late presentation, ability to bear weight, pain on passive rotation, tenderness of the groin area, diagnosis and treatment. Patients were divided into two groups, with hip fracture (occult hip fracture group) and without hip fracture (no fracture group) to evaluate the characteristics associated with an occult hip fracture. Results: The patients, a total of 139, had a mean age of 58.3 years and included 72 male patients(51.8%). The occult hip fracture group included 43 patients(30.9%). Of those 43, 21 patients(48.8%) had intertrochanteric or trochanteric fractures, 8 patients(18.6%) had femur neck fractures and 14 patients(32.6%) had acetabular fractures. Of the 43, 15 patients(34.9%) needed operative treatment. Age was higher in the occult hip fracture group than it was in the no fracture group($64.4{\pm}19.1$ years vs. $55.5{\pm}23.6$ years, p=0.021). A previous fracture was associated with the presence of a new fracture (p=0.014; OR=3.971, 95% CI=1.314-11.997). Conclusion: Further evaluation of patients who are older or have history of fractures is prudent, even though the initial X-rays are normal.

• Journal of Trauma and Injury
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• 제35권2호
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• pp.99-107
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• 2022

Purpose: The term "intentional injuries" refers to a spectrum of injuries resulting from self-inflicted injuries, interpersonal violence, and group acts of violence. Intentional injuries are underreported in Saudi Arabia. This study aimed to analyze and evaluate the characteristics of intentional injuries in patients who presented to the emergency department of a primary trauma center in Medina, Saudi Arabia in 2013. Methods: A prospective cohort database analysis of the clinical patterns and treatment outcomes of 252 patients who had intentional injuries between January and December 2013 was done. Results: The proportion of trauma patients with intentional injuries was 1.3%. The mean age was 34.2±9.4 years, 141 patients (56.0%) were male, and 111 (44.1%) were female (male to female ratio, 1.27:1). The majority (n=159, 63.1%) of injuries occurred at night. Most occurred outside the home (n=180, 71.0%). Financial problems (n=62, 24.6%) and social disputes (n=61, 24.2%) were the most common reasons. Sharp objects (n=93, 36.9%) were the most common weapons used. The head and neck were the most commonly injured areas (n=63, 54.4%). Superficial cuts (n=87, 34.5%), were the most common type of injury. Suturing of wounds (n=54, 21.4%) and surgical debridement (n=47, 18.7%) were the most commonly performed modalities of management. Conclusions: We conclude that intentional injuries in Saudi Arabia are a health care hazard that is, unfortunately, underreported. The clinical pattern is similar in most aspects to international reports but differs in certain features due to the specific religious and conservative characteristics of the community. Nationwide clinical studies are strongly recommended.

• Journal of Chest Surgery
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• 제8권2호
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• pp.119-124
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• 1975

This is a case report of the rupture of the trachea and the esophagus following external blunt trauma without any associated injury. A 7 year old male patient was brought to the emergency room. Hanyang University Hospital, on 23 Jul, 1974 while he played under the pile of pingpong table A table was fall down over the patient accidentally. The patient was injured by the table and found lying in unconsciousness on the ground.There was subcutaneous emphysema on his anterior chest and neck. A contusion on the upper part of the sternum was noted. The breathing sound were diminished over the left side of the chest. Ronchi were heard over the right lung field. This patient was suffered from vomiting, dypsnea, and irritable mental state after this accident. On the chest roentgenogram in A-P view, hyperlucency at the mediastinum and parapericardiac area suggested the pneumomediastinum. On the next day, a diagnosis of the tracheal and esophageal rupture was confirmed by the esophagogram with Lipiodol swallowing. A right thoracotomy was performed and ruptured orifice of the trachea and the esophagus were closed with interrupted sutures. Postoperative course was uneventful and primary closure of the rupture of the trachea and the esophagus were succeeded.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제39권
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• pp.31.1-31.5
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• 2017

Background: Dystrophic calcification can occur in any soft tissue with the absence of a systemic mineral imbalance and is often associated with trauma, infection, or inflammation. It is easily found in the site of the heart and skeletal muscles and rarely appears in the head and neck area. Case report: We present a rare case of multiple calcified masses in the left masseter muscle of a 26-year-old female with a history of trauma in the area. In computed tomography, multiple radiopaque masses were observed inside the left masseter muscle and blood test results were normal. The calcified masses were diagnosed as dystrophic calcification and removed by surgery without any complications. Conclusion: Different types of calcifications may occur in the cheek area, and they need to be distinguished from dystrophic calcification. Thorough clinical examination and history taking is required together with blood testing and radiographic examinations.

• 대한치과의사협회지
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• 제56권11호
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• pp.598-604
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• 2018

Cervicofacial subcutaneous emphysema is defined as the abnormal introduction of air into the subcutaneous tissues of the head and neck. It is mainly iatrogenic and traumatic in origin. Our two case reports are also due to the same cause, but the features of the trauma and the site of the dental treatment are different from the existing reports. A 29-year-old man visited our hospital with facial swelling and pain after experiencing facial trauma in a soccer game. Another 55-year-old woman visited with similar symptoms after replacement of her maxillary anterior fixed prosthesis. In the two cases presented, subcutaneous emphysema was gradually treated with no complications during antibiotic prophylaxis and supportive care. In this paper, we report two cases of traumatic and iatrogenic subcutaneous emphysema and their diagnoses, etiologies, complications, and treatments based on a literature review.

• Journal of Trauma and Injury
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• 제26권1호
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• pp.30-33
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• 2013

A 55-year-old woman was seen in the emergency department with posterior neck pain and a headache after a traffic accident. Physical examination revealed tenderness on palpation over the posterior skull and a midline spinous process of the cervical spine without neurologic deficit. A plain radiograph of the cervical spine demonstrated the absence of the lateral portion of the posterior arch of the atlas and very lucent shadowing of the anterior midline of the atlas, suggesting a fracture of the anterior arch. On three-dimensional computed tomography (CT) of the cervical spine, anterior and posterior bony defects of the atlas were noted. Well-corticated defects were noted with sclerotic change and with no evidence of soft tissue swelling adjacent to the bony discontinuities, consistent with a congenital abnormality. With conservative therapy, the patient gradually showed a lessening of the midline tenderness. Careful investigation with radiography or CT is needed for these patients to avoid confusion with a fracture, because these patients seldom need surgical treatment.

• 대한기관식도과학회지
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• 제4권2호
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• pp.165-170
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• 1998

Background and Objectives : Decannulation failure may result from factors such as inadequate ability 0 clear secretion, mucosal induration, granulation tissue, restenosis, tracheal wall depression and vocal cord palsy. We were to evaluate the effectiveness of surgical treatment on the basis of site and type of stenosis. Materials and Method : A series of 44 cases of decannulation difficulty between 1993 and 1997 were reviewed. The following data were collected on each of these patients : primary disease, indication for tracheostomy, site of stenosis, endoscopic findings of stenosis, surgical techniques used for treatment. Results : Primary diseases were 30 head trauma, 4 neck injury, 10 other diseases. Indication for tracheostomy were 37 prolonged intubation, 4 emergency tracheostomy, 3 laryngeal trauma. Endoscopic findings of stenosis were 24 granulation tissue, 16 laryngotracheal collapse, 4 combined with granulation tissue and collapse. Site of stenosis were 3 glottic, 9 subglottic, 24 stomal, 1 substomal, 7 mixed. 22 of 24 cases were decannulation using endoscopic treatment. Conclusion : The most common cause of failed decannulation was sternal granulation tissue. The most effective treatment of granulation tissue was endoscopic technique.

• Journal of Trauma and Injury
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• 제36권4호
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• pp.411-415
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• 2023

An odontoid process fracture is a serious type of cervical spine injury. This injury is categorized into three types based on the location of the fracture. Severe or even fatal neurological deficits can occur due to associated cord injury, which can result in complete quadriplegia. Computed tomography is the primary diagnostic tool, while magnetic resonance imaging is used to evaluate any associated cord injuries. These injuries can occur either directly from the injury or during transportation to the hospital if mishandled. There are two main treatment approaches: surgical fixation or external nonsurgical fixation, with various types and models of fixation devices available. In this case study, computed tomography follow-up confirmed that external fixation can yield successful results in terms of complete healing, even in cases complicated by other factors that may impede healing, such as pregnancy.

• Archives of Plastic Surgery
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• 제36권3호
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• pp.351-355
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• 2009

Purpose: Cervical necrotizing fasciitis tends to involve the deep soft tissues and spread caudally to the anterior chest and mediastinum, often resulting in major complications and death. It may rapidly spread into the thorax along fascial planes, and the associated diagnostic delay results in this descending necrotizing mediastinitis. So, aggressive multidisciplinary therapy with surgical drainage is mandatory. We present a very rare case of descending necrotizing mediastinitis with literature review. Methods: A 53 years old male visited our department 7 days after trauma in neck. His premorbid conditions and risk factors of necrotizing fasciitis were concealed hepatoma, trauma history, chronic liver disease, and nutrition deficit. Computed tomographic scans of the head and neck region were performed in this patient : signs of necrotizing fasciitis, were seen in the platysma, sternocleidomastoid, trapezius muscle and strap muscles of the neck. Fluid accumulations involved multiple neck spaces and mediastinum. At the time, he diagnosed as necrotizing fasciitis on his neck and anterior chest. Necrotic wound was excised serially and we treated this with the Vacuum - assisted closure(VAC, Kinetics Concepts International, San Antonio, Texas) system device. After appropriately shaping the sponge and achieving additional 3 pieces drainage tubes in the pockets, continuous negative pressure of 125 mmHg was applied. The VAC therapy was utilized for a period of 12 days. Results: We obtained satisfactory results from wide excision, abscess drainage with the VAC system, and then split thickness skin graft. The postoperative course was uneventful. Conclusion: The refined technique using the VAC system can provide a means of simple and effective management for the descending necrotizing mediastinitis, with better cosmetic and functional results. Finally, the VAC system has been adopted as the standard treatment for deep cervical and mediastinal wound infections as a result of the excellent clinical outcome.