• Journal of Trauma and Injury
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• v.18 no.2
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• pp.175-178
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• 2005

Fat embolism syndrome is a collection of respiratory, neurological and cutaneous symptoms and signs associated with trauma and other disparate surgical and medical conditions. The incidence of clinical syndrome is low while the embolization of marrow fat appears to be an almost inevitable consequence of long bone fractures. The pathogenesis is a subject of conjecture and controversy. There are two theories which have gained acceptance(mechanical theory, biochemical theory). Onset of symptom is usually within 12 to 72 hours, but may manifest as early as 6 hours to as late as 10 days. The classic triad of fat embolism syndrome involves pulmonary changes, cerebral dysfunction and petechial rash. The cornerstone of treatment is preventing the stress response, hypovolemia and hypoxia and operative stabilization of fractures. Corticosteroid are the only drugs which have repeatedly shown a positive effect on the prevention and treatment of fat embolism syndrome. We report a case of post-traumatic fat embolism syndrome with severe cerebral involvement without respiratory distress. A 55 years old female had a traffic accident. She sustained pelvic bone fracture and both humerus fracture. Approximately 4 hours after the accident, mental status change developed without a focal neurologic deficits. She had no respiratory symptom and sign. Her brain MRI showed multiple cerebral fat embolism lesion. The patients received supportive treatment with corticosteroid, albumin. Her neurologic status stabilized over several days. After orthopedic surgery, she was discharged 62 days after admission.

• Journal of Trauma and Injury
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• v.31 no.2
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• pp.103-106
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• 2018

Fat embolism refers to the presence of fat droplets within the peripheral and lung microcirculation with or without clinical sequelae. However, early diagnosis of fat embolism is very difficult because the embolism usually does not show at the computed tomography as a large fat complex within vessels. Forty-eight-year-old male with pedestrian traffic accident ransferred from a local hospital by helicopter to the regional trauma center by two flight surgeons on board. At the rendezvous point, he had suffered with dyspnea without any airway obstruction sign with 90% of oxygen saturation from pulse oximetry with giving 15 L of oxygen by a reserve bag mask. The patient was intubated at the rendezvous point. The secondary survey of the patient revealed multiple pelvic bone fracture with sacrum fracture, right femur shaft fracture and right tibia head fracture. Abdominal computed tomography was performed in 191 minutes after the injury and fat embolism with Hounsfield unit of -86 in his right common iliac vein was identified. Here is a very rare case that mass of fat embolism was shown within common iliac vein detected in computed tomography. Early detection of the fat embolus and early stabilization of the fractures are essential to the prevention of sequelae such as cerebral fat embolism.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.58-64
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• 2006

Purpose: Management of soft-tissue defect after open tibial fractures includes immediate and repeated debridement, skeletal stabilization, and early soft-tissue coverage with muscle flaps. The purpose of this study was to evaluate the outcome of the free rectus abdominis muscle flap (RA flap) for treatment of open fractures of the tibia and to discuss its advantages compared with the latissimus dorsi muscle flap (LD flap) in poly trauma patients. Materials and Methods: We performed a retrospective review of 5 patients who had a severe (Gustilo IIIb or IIIc) open fracture of the tibia treated with RA flap from May 2003 to March 2006. All were men, and the mean age was 46.6 years (range, $28{\sim}68$). Three patients had combined injuries such as pelvic bone fractures, multiple rib fractures with hemothorax, and contralateral tibial fracture. All patients received RA flap within 7 days after trauma except two with established chronic osteomyelitis. Results: All flaps survived, and there was no marginal flap necrosis. During the follow-up period, there was no evidence of persistent or recurrent osteomyelitis. The size of RA flap ranged from $8{\sim}20\;cm$ in length and $6{\sim}10\;cm$ in width. The average time required for RA flap elevation was 32 minutes, which is shorter than LD flap. Flap elevation could be done in supine position which is essential in poly trauma patients. Conclusion: Although a wide variety of options are available, RA flap is regarded as an optimal method for coverage of soft-tissue defect of the open tibial fracture in poly trauma patients. LD flap is reserved for large sized soft-tissue defect which cannot be covered by RA flap.

• Journal of Chest Surgery
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• v.12 no.4
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• pp.418-423
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• 1979

Chest injuries due to blunt trauma often result in severe derangements that lead to death. And we have to diagnose and treat the patients who have blunt chest trauma immediately and appropriately. A clinical analysis was made on 324 cases of chest injury due to blunt trauma experienced at department of Thoracic and Cardiovascular Surgery, College of Medicine, Kyung Hee University during 8-year period from 1972 to 1979. Of 324 patients of blunt chest injuries, there were 189 cases of rib fracture, 121 of hemothorax or/and pneumothorax, 108 of soft tissue injury of the chest wall only, 41 of lung contusion, 24 of flail chest, 13 of scapular fracture, 7 of diaphragmatic rupture and others. The majority of blunt chest injury patients were traffic accident victims and falls accounted for the next largest group of accidents. Chest injuries were frequently encountered in the age group between 3rd decade and 4th decade [60%] and 238 patients were male comparing to 86 of female [Male: Female = 3:1 ]. In the patients who have the more number of fractured ribs, the more incidence of intrathoracic injury and intraabdominal organ damage were found. The principal associated injuries were head injury on 58 cases, long bone fractures on 37, skull fractures on 12, pelvic fractures on 10, renal injuries on 6 and intraabdominal organ injuries on 5 patients. The principle of early treatment of chest injury due to blunt trauma were rapid reexpansion of the lung by closed thoracotomy which was indicated on 96 cases, but open thoractomy was necessary on 14 cases because massive bleeding, intrapleural hematoma and/or fibrothorax, or diaphragmatic laceration-On 15 cases who were young and have multiple rib fracture with severe dislocation delayed elective open reduction of the fractured ribs with wire was done on the purpose of preserving normal active life. The over all mortality was 2.8% [9 of 324 cases] due to head injury on 3 cases, massive bleeding on 2,wet lung syndrome, acute renal failure on 1 and septicemia on 1 patient.

• Journal of Trauma and Injury
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• v.30 no.4
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• pp.238-241
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• 2017

A 52-year-old man experienced blunt trauma upon falling from a height of 40 m while trying to repair the elevator. The patient's systolic blood pressure and hemoglobin levels were 60 mmHg and 7.0 g/dL, respectively, upon admission. A large volume of bloody discharge was observed in the open wound of the perianal area and sacrum. A computed tomography scan revealed an open comminuted sacral fracture with multiple contrast blushes. He underwent emergency laparotomy. Both internal iliac artery ligations were performed to control bleeding from the pelvis. Protective sigmoid loop colostomy was performed because of massive injury to the anal sphincters and pelvis. Pad packing was performed for a sacral open wound and perineal wound at the prone position. After resuscitation of massive transfusion, he underwent the second operation 2 days after the first operation. The pad was removed and the perineal and sacral open wounds were closed. After the damage-control surgery, he recovered safely. In this case, the hemodynamically unstable, open comminuted sacral fracture was treated safely by internal iliac artery ligation with pad packing.

• Journal of Trauma and Injury
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• v.27 no.4
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• pp.215-218
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• 2014

Blunt abdominal trauma may often cause multiple vascular injuries. However, common iliac artery injuries without associated bony injury are very rarely seen in trauma patients. In the present case, a 77-year-old male patient who had no medical history was admitted via the emergency room with blunt abdominal trauma caused by a forklift. At admission, the patient was in shock and had abdominal distension. On abdomino-pelvic computed tomography (CT), the patient was seen to have hemoperitoneum, right common iliac artery thrombosis and left common iliac artery rupture. During surgery, an additional injury to inferior vena cava was confirmed, and a primary repair of the inferior vena cava was successfully performed. However, the bleeding from the left common iliac artery could not be controlled, even with multiple sutures, so the left common iliac artery was ligated. Through an inguinal skin incision, the right common iliac artery thrombosis was removed with a Forgaty catheter and a femoral-to-femoral bypass graft was successfully performed. After the post-operative 13th day, on a follow-up CT angiography, the femoral-to-femoral bypass graft was seen to have good patency, but a right common iliac artery dissection was diagnosed. Thus, a right common iliac artery stent was inserted. Finally, the patient was discharged without complications.

• Journal of Trauma and Injury
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• v.35 no.3
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• pp.215-218
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• 2022

The rectum is the least frequently injured organ in trauma, with an incidence of about 1% to 3% in trauma cases involving civilians. Most rectal injuries are caused by gunshot wounds, blunt force trauma, and stab wounds. A 46-year-old male patient was crushed between two vehicles while he was working. He was hemodynamically unstable, and the Focused Assessment with Sonography for Trauma showed hemoperitoneum and hemoretroperitoneum; therefore, damage control surgery with pelvic packing was performed. A subsequent whole-body computed tomography scan showed a displaced pelvic bone and sacrum fracture. There was evidence of an anorectal full-thickness laceration and urethral laceration. In second-look surgery performed 48 hours later, the pelvis was stabilized with external fixators, and it was decided to proceed with loop sigmoid colostomy. A tractioned rectal probe with an internal balloon was positioned in order to approach the flaps of the rectal wall laceration. On postoperative day 13, a radiological examination with endoluminal contrast injected from the stoma after removal of the balloon was performed and showed no evidence of extraluminal leak. Rectosigmoidoscopy, rectal manometry, anal sphincter electromyography, and trans-stomic transit examinations showed normal findings, indicating that it was appropriate to proceed with the closure of the colostomy. The postoperative course was uneventful. The optimal management for extraperitoneal penetrating rectal injuries continues to evolve. Primary repair with fecal diversion is the mainstay of treatment, and a conservative approach to rectal lacerations with an internal balloon in a rectal probe could provide a possibility for healing with a lower risk of complications.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.212-218
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• 1980

A severe crushing injury of the chest produce a very striking syndrome referred to as traumatic asphyxia. This syndrome is characterized by bluish-red discoloration of the skin which is limited to the distribution of the valveless veins of the head and neck. And also if it is characterized by bilateral subconjunctival hemorrhages and neurological manifestations. But these clinical entities faded away progressively in a few weeks. Apporximately 90% of the patients who live for more than a few hours will recover from traumatic asphyxia when it occurs as a single entity. And so, death results from either severe associated injuries of from subsequent infection, rather than from pulmonary or cardiac insufficiency in traumatic asphyxia. We have experienced 4 cases of traumatic asphyxia with severe crushing thoracic injuries at department of the chest surgery, Captial Armed forces General Hospital during about 3 years from April 1977 to Aug. 1980. The 1st 22 year-old male was struct 2$\frac{1}{2}$ ton truck on the road and was transferred to this hospital immediately. He had taken tracheostomy due to severe dyspnea with contusion pneumonia and for removal of a large amount of bronchial secretion. The 2nd case was 23 year-old male who was got buried in a chasm. In this case, the heavy metal post tumbled over him back while at work. The 3rd case was 39 year-old male who leapt out of a window in 5th story while fire broke out in living room by oil stove heating. He had multiple rib fracture with right hemothor x and right colle's fracture and pelvic bone fracture. The last 22 year-old male was run over by a gun carriage. The wheel of this gun carriage passed over his thorax and right chin. He was brought to this hospital by helicopter. when he was first examined at emergency room, he was in semicomatose state and has pneurmomediastinum with multiple rib fracture and severe subcutaneous emphysema. As soon as he arrived, bilateral closed thoracostomy was performed and cardiopulmonary resuscitation was done. In hospital 8th weeks, chest series showed fibrothorax in right side even if chest wall stabilized. All 4 cases had multiple petechiae over their facees and chest and bilateral subconjunctival hemorrhages referred to as traumatic asphyxia. 3 cases except one case who received splenectomy, had been suffered from contusion pneumonia and had been treated with respiratory care. In these 3 cases, they had warning of impending injury before accident, and took a deep breath hold it and braces himself. And also, even if he had not impending fear in remaining one case, he had taken a deep breath and had got valsalva maneuver for pulling off the heavy metal post. Intrathoracic pressure rose suddenly and resulted to traumatic asphyxia in this situation. All these cases were recovered completely without sequelae except one fibrothorax, right.

• Journal of Korean Neurosurgical Society
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• v.63 no.5
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• pp.623-630
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• 2020

Objective : A primary degenerative sagittal imbalance has been considered because of unique lifestyles such as the prolonged crouched posture during agricultural work and performing activities of daily living on the floor. Previous papers have reported that sagittal imbalance disease is often seen distinctly in the farming districts of "oriental" countries such as Korea and Japan. However, this finding was only evaluated with the use of X-ray, and other factors such as magnetic resonance imaging (MRI), muscle volume, compression fracture, and laboratory results were not considered. Thus, using these, we evaluate the agricultural work-associated factors for Korean elderly spinal sagittal imbalance. Methods : We recruited 103 Korean participants who had a sagittal vertical axis (SVA) of >5 cm in this Korean Elderly Sagittal Imbalance Cohort Study. The following were evaluated : radiological parameters, MRI, compression fracture, vitamin D, parathyroid hormone, C-terminal telopeptide, osteocalcin, bone mineral density and muscle fatty change, muscle volume, and health-related quality of life from patients' survey. Moreover, in this survey, the farmers' annual working hours were investigated. Subsequently, we analyzed the associated factors for spinal sagittal imbalance depending on occupation. Results : A total of 46 participants were farmers, and the others were housewives, sellers, and office workers. The farmer group had more SVA (141 vs. 99 mm, p=0.001) and pelvic tilt (31° vs. 24°, p=0.004) and lesser lumbar lordosis (20° vs. 30°, p=0.009) and thoracic kyphosis (24° vs. 33°, p=0.03) than non-farmer group. A significantly positive correlation was noted between the working hour and SVA in the farmer group (p=0.014). The visual analogue scale score for back pain (8.26 vs. 6.96, p=0.008) and Oswestry Disability Index (23.5 vs. 19.1, p=0.003) in the farmer group were higher than that in the non-farmer group, but the Short Form-36 score was not significantly different between the two groups. The Mini-Mental State Exam score was significantly lower in the farmer group than in the non-farmer group (24.85 vs. 26.98, p=0.002). Conclusion : The farmer group had more sagittal imbalance and back pain in proportion to the working hours even though the muscle and bone factors and general laboratory condition were not significantly different between the two groups. These results supported that the long hours spent in the crouched posture while performing agricultural work were a risk factor for severe sagittal imbalance.

• Journal of The Korean Society of Clinical Toxicology
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• v.3 no.2
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• pp.122-125
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• 2005

Paraquat, is a widely used for its great effect as a herbicide. But the mortality rate by paraquat intoxication is known to be very high. It is thought to act by changing form to superoxide and peroxide free radical. Almost paraquat intoxication is through ingestion. A few intoxication of paraquat is through skin absorption. But there was no known death case through skin absorption. We experienced a case of a expired patient by paraquat intoxication through skin abrasion and scratching wound. A 75-year-old man was visited emergency room after motorcycle accident during transporting paraquat. He has multiple abrasion and scratching wound on extremities, and pelvic bone fracture. There was no evidence of ingestion of paraquat. But serum/urine gramoxone level was all positive. In spite of wound irrigation and hemoperfusion, his condition was been gone form bed to worse. 2 days after, multiple organ failure and the respiratory arrest were developed and he was expired. Paraquat intoxication through skin wound is extremely dangerous and death by that could possibly happen