Journal of Trauma and Injury最新文献

This case report describes the diagnosis and surgical management of a shrapnel wound to the neck with a retained foreign body (metal fragment) in the anterior mediastinum. A 44-year-old male service member was wounded in the neck during an air raid. Thirty minutes after sustaining the injury, the patient reached a forward surgical team, exhibiting hemodynamic instability responsive to resuscitation. After initial stabilization, the forward team performed primary surgical treatment of the wound, including hemostasis, irrigation and debridement, and drainage. Twelve hours later, the patient was transported by ground to the Military Medical Clinical Center of the Northern Region of the Military Medical Center of the Armed Forces of Ukraine and hospitalized in the surgical department. Diagnostic evaluation included computed tomography of the head, chest, abdomen, and pelvis along with esophagogastroduodenoscopy, which demonstrated fracture of left ribs 1 and 2, a 40×15-mm metal fragment in the anterior superior mediastinum with pneumomediastinum and hemomediastinum, and metal fragments in the soft tissues of the neck without contrast extravasation. Esophagogastroduodenoscopy revealed no evidence of esophageal injury. Surgical management included left video-assisted thoracoscopic surgery with opening of the anterior mediastinum and removal of the foreign body (metal shrapnel fragment) using a magnetic surgical instrument. The patient was discharged 2 weeks postoperatively. Gunshot wounds of the neck with a large foreign body in the anterior mediastinum are rare. The use of minimally invasive surgical techniques and modern magnetic surgical instruments can reduce surgical morbidity and may be used at tertiary care centers.

Purpose: The management of midshaft clavicle fractures varies depending on fracture characteristics, patient demographics, and surgeon preferences. However, global differences in practice patterns and surgical decision-making for this injury remain poorly characterized.

Methods: An international survey was conducted through Orthobullets between March 2021 and September 2024, targeting practicing orthopedic surgeons. Standardized polls, created collaboratively using the best available evidence and a peer-reviewed, evidence-based item list, were designed to capture global treatment preferences. Analyses were then performed to evaluate variation across subspecialties and practice environments. Multivariable regression was applied to examine associations between subspecialty, practice type, the likelihood of selecting operative management, and the preferred surgical techniques.

Results: The study included 2,364 surgeons from 76 countries. Overall, 46% (1,076 of 2,337 respondents) selected operative treatment, with notable regional differences. Surgeons from Asia (odds ratio [OR], 1.650), Africa (OR, 1.988), and Latin America (OR, 1.785) were more likely to choose surgery, whereas those from Oceania (OR, 0.464) were less likely. Trauma specialist were 1.45 times more likely to offer operative management. Regarding immobilization, 73.4% preferred a sling, while 23.4% chose a figure-of-eight brace. Among surgeons opting for surgery, 93% (1,479 of 1,590 respondents) selected open reduction and internal fixation with plates and screws.

Conclusions: This study demonstrates a notable trend toward operative management of midshaft clavicle fractures, influenced by subspecialty and practice environment. These findings highlight the evolving landscape of fracture care and emphasize the need for standardized approaches and broader understanding across diverse healthcare systems.

Conservative treatment for valgus-impacted fractures can yield a high union rate; however, determining the ideal indications for this approach remains challenging. Older adults may sustain bilateral hip fractures from low-impact falls, typically presenting a symmetric fracture pattern. Nonetheless, asymmetric bilateral hip fractures, though extremely rare, have been documented. This report describes a case of a 78-year-old woman who presented after a low-impact fall at home. Her medical history included a previous fall 3 months earlier, resulting in a Garden I right femoral neck fracture treated conservatively in another department of our institution. Radiological examination revealed a left peritrochanteric fracture and a displaced (Garden IV) subcapital fracture of the right hip. Both fractures were treated surgically on the same day, with cephalomedullary nailing of the left femur followed by cemented bipolar hemiarthroplasty of the right femur. The postoperative course was uneventful, and the 1-year follow-up was satisfactory. The surgical sequence was chosen to facilitate intraoperative positioning, minimize the risk of prosthetic dislocation, and allow accurate restoration of leg length using the fixation as a reference point for hemiarthroplasty. This case highlights the importance of individualized treatment planning and careful consideration of surgical fixation for older adults with valgus-impacted femoral neck fractures who are at high risk of subsequent falls and hip fractures.

Purpose: In February 2024, a healthcare system crisis in Korea, triggered by the mass resignation of medical residents in protest of government medical policies, resulted in an increased influx of civilian trauma patients to a military trauma center. This study examines the scale, characteristics, and treatment outcomes of these patients before and during the crisis.

Methods: A retrospective review was conducted, comparing civilian trauma patients who visited the center from March 2023 to February 2024 (before crisis) and from March 2024 to February 2025 (during the crisis). The variables analyzed included patient demographics, injury types, methods of transportation, length of emergency room (ER) stay, hospitalization outcomes, and final treatment results. Only civilian trauma patients who required hospitalization were included; mild cases discharged from the ER were excluded.

Results: A total of 548 civilian patients visited the center during the study period, with a significant increase observed during the crisis (364 patients during the crisis vs. 81 patients before the crisis). Despite the surge, there were no significant differences in hospital arrival routes, methods of transportation, mechanisms of injury, or injury types. ER stay durations were shorter for both general and severe cases during the crisis (P=0.020 and P=0.033, respectively), although intensive care unit and overall hospital stay lengths remained unchanged. Civilian outpatient visits increased more than threefold in March 2024 compared to February 2024, and this elevated trend remained stable.

Conclusions: These findings highlight the military trauma center's ability to maintain effective civilian trauma care despite significant healthcare system disruptions. The study underscores the resilience of the center and offers insights for optimizing trauma care operations in future crises.

Facial trauma is a complex and important contributor to trauma-related morbidity, often requiring multidisciplinary management due to intricate anatomy and the dual need for functional and aesthetic restoration. This case series describes a spectrum of maxillofacial injuries treated by trauma surgeons, including soft tissue degloving, zygomaticomaxillary complex fractures, mandibular fractures, and airway compromise. All patients were managed in accordance with Advanced Trauma Life Support (ATLS) principles. Surgical interventions included layered wound closure, open reduction and internal fixation, and airway management through endotracheal intubation, cricothyroidotomy, or tracheostomy. The series underscores the critical decision-making required in airway management, the surgical expertise necessary for fracture stabilization, and the importance of early reconstruction in optimizing outcomes. It further emphasizes the role of trauma surgeons in delivering comprehensive care and highlights the value of preventive strategies such as helmet use and road safety enforcement. These cases contribute to the growing evidence that timely, coordinated surgical intervention supports optimal recovery in patients with facial trauma.

Purpose: Traumatic soft tissue defects present challenges due to their diverse presentations. This variability necessitates tailored approaches for effective management, requiring advanced reconstruction strategies to achieve rapid coverage and tissue infill while minimizing complications. The study aimed to evaluate the safety of ovine forestomach matrix (OFM) grafts in traumatic defects from four level I trauma centers.

Methods: This prospective observational study used a multicenter registry to collect deidentified data from adult trauma/acute care surgery patients who received OFM-based grafts for soft tissue repair from August 2022 through September 2024. After the application of OFM grafts, defects were regularly assessed for the development of vascularized tissue coverage and/or fill, and ultimately epithelialization.

Results: During the study, 49 participants with 61 soft tissue defects underwent procedures with OFM-based grafts. The mean participant age was 58.8±17.7 years. Most defects (55.7%) resulted from traumatic injuries, with additional etiologies including necrotizing soft tissue infections (13.1%), enterocutaneous fistulas (4.9%), acute pressure injuries (stages III and IV, 6.6%), surgical dehiscence (4.9%), amputations (3.3%), and hematoma evacuation (3.3%). All defects achieved vascularized tissue coverage within a median of 22.5 days (interquartile range, 13.3-33.5 days) after a median of one product application (interquartile range, 1-1). Four cases of superficial infection were reported, all resolving without major complications.

Conclusions: OFM-based grafts showed promising results in tissue regeneration for trauma and acute care defects, with minimal postoperative complications. These results are interim findings from an ongoing prospective multicenter registry study evaluating the safety and efficacy of OFM-based grafts in various surgical applications.

Polytrauma triggers a complex systemic inflammatory response, and early identification of high-risk patients is essential for guiding timely interventions and improving outcomes. Interleukin-6 (IL-6), a rapidly induced proinflammatory cytokine, has emerged as a potential biomarker for prognosis in the trauma setting. This narrative review summarizes current evidence on the prognostic role of IL-6 in polytrauma patients, addressing its biological functions, kinetics after injury, and associations with clinical outcomes such as acute respiratory distress syndrome, multiple organ dysfunction syndrome, intensive care unit admission, and mortality. IL-6 levels have been shown to correlate with injury severity scores and to predict complications more reliably than many other inflammatory markers, largely due to its early elevation and sustained presence in circulation. Furthermore, IL-6 measurement may inform surgical decision-making, particularly in selecting candidates for damage control strategies versus definitive care. Compared to other cytokines and acute-phase reactants, IL-6 demonstrates superior temporal responsiveness and prognostic accuracy in the early postinjury phase. Despite variability in measurement methods and the influence of external confounding factors, IL-6 holds significant promise as a clinical tool for early triage, risk stratification, and potentially therapeutic targeting in trauma care. Standardized protocols and larger multicenter studies are needed to facilitate broader adoption and integration of IL-6 into clinical algorithms.

Purpose: Traumatic injuries during pregnancy present significant challenges for emergency providers, necessitating rapid assessment to ensure the safety of both mother and fetus. Scoring systems that can be applied immediately upon presentation may facilitate early triage and inform disposition decisions. This study evaluated the predictive performance of the Obstetric Early Warning Score (OEWS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) in determining hospitalization needs among pregnant trauma patients admitted to the emergency department (ED).

Methods: This retrospective cross-sectional study included pregnant trauma patients aged 18 years or older who were admitted to a tertiary care ED between January 2019 and December 2022. Demographic, clinical, laboratory, and trauma-related data were collected. OEWS, ISS, and RTS were calculated at admission. The primary outcome was the requirement for hospitalization. Binary logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess predictive performance.

Results: A total of 316 pregnant trauma patients were included. Hospitalization was required in 14.9% of cases. Higher OEWS (mean, 2.63 vs. 0.33; P=0.001) and ISS (mean, 18.02 vs. 5.04; P<0.001) were significantly associated with hospitalization. In multivariate analysis, OEWS (odds ratio [OR], 1.553; 95% confidence interval [CI], 1.087-2.219; P=0.016) and ISS (OR, 1.170; 95% CI, 1.083-1.264; P<0.001) were independent predictors of hospitalization. ROC analysis demonstrated that ISS had the highest predictive value (area under the curve, 0.783; 95% CI, 0.695-0.870; P<0.001).

Conclusions: Both ISS and OEWS are effective tools for predicting hospitalization needs in pregnant trauma patients. Incorporating these scoring systems into ED triage protocols may enhance early identification of high-risk patients and improve outcomes for both mothers and fetuses.

A 41-year-old man presented with discomfort in the medial arch of his foot, which worsened with weight-bearing. The condition had initially been misdiagnosed as plantar fasciitis, and he had received conservative treatment without imaging, with no relief of symptoms. Plain radiography and computed tomography later revealed a 2.5-cm radiopaque, needle-like foreign body in the superficial midfoot. Further history-taking revealed that the patient had stepped on a sewing needle during childhood, approximately 35 years earlier. The foreign body was surgically removed through an extended incision, as it was encased in granulomatous tissue and was not easily accessible via a minimally invasive approach. Histopathological examination confirmed a fibrous reaction with granuloma formation surrounding the retained metallic object. The patient remained asymptomatic postoperatively and returned to normal activity. To the author's knowledge, this is the first reported case of a sewing needle retained in the foot for over 30 years without an allergic reaction or infection. Although many foreign bodies are detected shortly after injury, this case highlights the importance of thorough history-taking and appropriate imaging, especially when symptoms mimic common conditions such as plantar fasciitis. Additionally, in long-standing cases, complete encapsulation by reactive tissue may necessitate more extensive surgical exposure for successful removal.

Isolated orbital roof fractures are rare, accounting for less than 0.2% of all facial fractures. They usually result from high-velocity impacts and are frequently associated with additional facial, ocular, and neurological trauma, necessitating a multidisciplinary team approach. In this report, we present a case of an isolated orbital roof fracture complicated by orbital compartment syndrome, severe proptosis, vision loss, corneal abrasion, subdural hemorrhage, and a dural tear. Surgical intervention was initially delayed due to logistical constraints. Ultimately, fracture reduction and orbital roof reconstruction were successfully performed using a split calvarial bone graft. Postoperatively, there was marked improvement in proptosis and visual function; however, the patient continued to experience residual visual impairment due to corneal laceration. Although less common, orbital roof fractures represent a potentially serious form of craniofacial trauma. Standardized treatment protocols remain difficult to establish, given the rarity of such injuries. Repair methods are primarily directed at separating intracranial from intraorbital contents. A coordinated interdisciplinary approach involving plastic surgery, ophthalmology, and neurosurgery is essential for comprehensive patient management.