• Journal of Trauma and Injury
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• v.34 no.4
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• pp.225-232
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• 2021

Purpose: Trauma is the top cause of death in people under 45 years of age. Deaths from severe trauma can have a negative economic impact due to the loss of people belonging to socio-economically active age groups. Therefore, efforts to reduce the mortality rate of trauma patients are essential. The purpose of this study was to investigate preventable mortality in trauma patients and to identify factors and healthcare-related challenges affecting mortality. Ultimately, these findings will help to improve the quality of trauma care. Methods: We analyzed the deaths of 411 severe trauma patients who presented to Gachon University Gil Hospital regional trauma center in South Korea from January 2015 to December 2017, using an expert panel review. Results: The preventable death rate of trauma patients treated at the Gachon University Gil Hospital regional trauma center was 8.0%. Of these, definitely preventable deaths comprised 0.5% and potentially preventable deaths 7.5%. The leading cause of death in trauma patients was traumatic brain injury. Treatment errors most commonly occurred in the intensive care unit (ICU). The most frequent management error was delayed treatment of bleeding. Conclusions: Most errors in the treatment of trauma patients occurred in early stages of the treatment process and in the ICU. By identifying the main causes of preventable death and errors during the course of treatment, our research will help to reduce the preventable death rate. Appropriate trauma care systems and ongoing education are also needed to reduce preventable deaths from trauma.

• Journal of Trauma and Injury
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• v.33 no.2
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• pp.63-73
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• 2020

• Clinics in Shoulder and Elbow
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• v.25 no.1
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• pp.65-67
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• 2022

Pure anterior bilateral shoulder dislocations are rare clinical features, especially in traumatic forms. They are most often posterior, occurring during an epileptic seizure. Few cases are described in the literature, and the mechanism varies from case to case. We report a specific case of pure bilateral anterior shoulder dislocation in a 29-year-old judo player following an accident during his training and discuss the circumstances, mechanism, treatment, and prognosis.

• Journal of Trauma and Injury
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• v.33 no.3
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• pp.139-139
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• 2020

• Journal of Trauma and Injury
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• v.31 no.1
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• pp.16-18
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• 2018

Delayed esophageal rupture due to blunt injury is not new. However, rupture due to suspected barotrauma is very rare. We describe a case of esophageal rupture in a male 24-year-old patient after diving in shallow waters. The patient was quadriplegic and could not experience the typical chest pain related to rupture and resulting mediastinitis. The rupture was discovered 4 days after emergency decompressive laminectomy and fusion for his cervical spine. The rupture was evidently caused by barotrauma and was discovered four days after admission. He underwent primary closure and pericardial flap as a life-saving procedure.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.41
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• pp.22.1-22.2
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• 2019

• Clinics in Shoulder and Elbow
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• v.24 no.3
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• pp.183-188
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• 2021

We report a case of a 69-year-old right-dominant man who had an open Monteggia-like lesion of the right elbow (Gustilo-Andersen IIIA) with severe proximal ulna bone loss associated with an ipsilateral ulnar shaft fracture due to a motorcycle accident. The patient underwent two-stage surgery. Wound debridement and bridging external fixation were performed at first. Three months later, a frozen massive osteochondral ulnar allograft was implanted and fixed with a locking compression plate. A superficial wound infection appeared 5 weeks after the second surgery. Superficial wound debridement, negative pressure therapy, and antibiotics were administered for 3 months, achieving infection healing. At 3 years post-surgery, the elbow range of motion was satisfactory with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 16.7. Radiographs and computed tomography scans showed good allograft-bone integration without allograft reabsorption or hardware loosening. Although not complication-free, massive ulna osteochondral allograft implantation can be considered a valid option in cases of open Monteggia-like lesions associated with ulnar shaft fracture and severe bone loss in active patients, whenever osteosynthesis or joint replacement is not a proper solution. This type of bone stock restoration allows for future surgery, if needed.

• Journal of Trauma and Injury
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• v.31 no.1
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• pp.12-15
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• 2018

Rib fixations for flail chest or displaced rib fractures are not a new technique. However, reports on rib fixations involving costal cartilage fractures are very few and surprisingly there are no reports of internal fixations involving only the costal cartilage in the English literature. The diagnosis is difficult and the necessity of the procedure may be quite controversial. Placing plates in screws into the costal cartilage alone may seem unstable and easily dislodged or stripped through the cartilage. We report a 31-year-old male scuba diver instructor who underwent rib fixations over his 7th and 8th costal cartilage ribs for severe pain. The procedure was done with conventional plates and screws. He had the plates and screws removed 2 months later due to lingering pain, but with them removed he is now quite happy with the results without pain. The procedure for fixation of painful overlapped costal cartilage is quite simple and can be done with the usual conventional methods, fixating plate and screws directly over the cartilage alone without fixation over the bony rib.

• Journal of Trauma and Injury
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• v.33 no.1
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• pp.38-42
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• 2020

Purpose: Immediate post-laparotomy hypotension (PLH) is a precipitous drop in blood pressure caused by a sudden release of abdominal tamponade after laparotomy in cases of severe hemoperitoneum. The effect of laparotomy on blood pressure in patients with significant hemoperitoneum is unknown. Methods: In total, 163 patients underwent laparotomy for trauma from January 1, 2013 to December 31, 2015. Exclusion criteria included the following: negative laparotomy, only a hollow viscous injury, and hemoperitoneum <1,000 mL. After applying those criteria, 62 patients were enrolled in this retrospective review. PLH was defined as a decrease in the mean arterial pressure (MAP) ≥10 mmHg within 10 minutes after laparotomy. Results: The mean estimated hemoperitoneum was 3,516 mL. The incidence of PLH was 23% (14 of 62 patients). The MAP did not show significant differences before and after laparotomy (5 minutes post-laparotomy, 67.5±16.5 vs. 68.3±18.8 mmHg; p=0.7; 10 minutes post-laparotomy, 67.5±16.5 vs. 70.4±18.8 mmHg; p=0.193). The overall in-hospital mortality was 24% (15 of 62 patients). Mortality was not significantly higher in the PLH group (two of 14 [14.3%] vs. 13 of 48 [27.1%]; p=0.33). No statistically significant between-group differences were observed in the intensive care unit and hospital stay. Conclusions: PLH may be less frequent and less devastating than it is often considered. Surgical hemostasis during laparotomy is important. Laparotomy with adequate resuscitation may explain the equivalent outcomes in the two groups.

• Journal of Trauma and Injury
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• v.30 no.4
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• pp.140-144
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• 2017

Purpose: The optic nerve sheath diameter (ONSD) measured by ultrasonography is among the indicators of intracranial pressure (ICP) elevation. However, whether ONSD measurement is useful for initial treatment remains controversial. Thus, this study aimed to investigate the relationship between ONSD measured by computed tomography (CT) and ICP in patients with traumatic brain injury (TBI). Methods: A total of 246 patients with severe trauma from January 1, 2015 until December 31, 2015 were included in the study. A total of 179 patients with brain damage with potential for ICP elevation were included in the TBI group. The remaining 67 patients comprised the non-TBI group. A comparison was made between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the accuracy of ONSD when used as a screening test for the TBI group including those with TBI with midline shift (with elevated ICP). Results: The mean injury severity score (ISS) and glasgow coma scale (GCS) of all patients were $24.2{\pm}6.1$ and $5.4{\pm}0.8$, respectively. The mean ONSD of the TBI group ($5.5{\pm}1.0mm$) was higher than that of the non-TBI group ($4.7{\pm}0.6mm$). Some significant differences in age ($55.3{\pm}18.1$ vs. $49.0{\pm}14.8$, p<0.001), GCS ($11.7{\pm}4.1$ versus $13.3{\pm}3.0$, p<0.001), and ONSD ($5.5{\pm}1.0$ vs. $4.7{\pm}0.6$, p<0.001) were observed between the TBI and the non-TBI group. An ROC analysis was used to assess the correlation between TBI and ONSD. Results showed an area under the ROC curve (AUC) value of 0.752. The same analysis was used in the TBI with midline shift group, which showed an AUC of 0.912. Conclusions: An ONSD of >5.5 mm, measured on CT, is a good indicator of ICP elevation. However, since an ONSD is not sensitive enough to detect an increased ICP, it should only be used as one of the parameters in detecting ICP along with other screening tests.