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Comparison of mortality between open and closed pelvic bone fractures in Korea using 1:2 propensity score matching: a single-center retrospective study 利用 1:2 倾向评分匹配比较韩国开放性骨盆骨折和闭合性骨盆骨折的死亡率:一项单中心回顾性研究
Pub Date : 2024-01-03 DOI: 10.20408/jti.2023.0063
Jae-Du Yoo, D. Choi, B. Kang
Purpose: Open pelvic bone fractures are relatively rare and are considered more severe than closed fractures. This study aimed to compare the clinical outcomes of open and closed severe pelvic bone fractures. Methods: Patients with severe pelvic bone fractures (pelvic Abbreviated Injury Scale score, ≥4) admitted at a single level I trauma center between 2016 and 2020 were retrospectively analyzed. Patients aged <16 years and those with incomplete medical records were excluded from the study. The patients were divided into open and closed fracture groups, and their demographics, treatment, and clinical outcomes were compared before and after 1:2 propensity score matching. Results: Of the 321 patients, 24 were in the open fracture group and 297 were in the closed fracture group. The open fracture group had more infections (37.5% vs. 5.7%, P<0.001) and longer stays in the intensive care unit (median 11 days, interquartile range [IQR] 6–30 days vs. median 5 days, IQR 2–13 days; P=0.005), but mortality did not show a statistically significant difference (20.8% vs. 15.5%, P=0.559) before matching. After 1:2 propensity score matching, the infection rate was significantly higher in the open fracture group (37.5% vs. 6.3%, P=0.002), whereas the length of intensive care unit stay (median 11 days, IQR 6–30 days vs. median 8 days, IQR 4–19 days; P=0.312) and mortality (20.8% vs. 27.1%, P=0.564) were not significantly different. Conclusions: The open pelvic fracture group had more infections than the closed pelvic fracture group, but mortality was not significantly different. Aggressive treatment of pelvic bone fractures is important regardless of the fracture type, and efforts to reduce infection are important in open pelvic bone fractures.
目的:开放性骨盆骨骨折相对罕见,被认为比闭合性骨折更为严重。本研究旨在比较开放性和闭合性严重骨盆骨折的临床疗效。研究方法回顾性分析2016年至2020年间在一家一级创伤中心收治的严重骨盆骨骨折患者(骨盆简易损伤量表评分≥4分)。研究排除了年龄小于 16 岁和病历不完整的患者。研究人员将患者分为开放性骨折组和闭合性骨折组,并比较了1:2倾向评分匹配前后的人口统计学、治疗和临床结果。研究结果在 321 名患者中,开放性骨折组有 24 人,闭合性骨折组有 297 人。开放性骨折组的感染率更高(37.5% 对 5.7%,P<0.001),在重症监护室的住院时间更长(中位数 11 天,四分位数间距 [IQR] 6-30 天,对中位数 5 天,四分位数间距 [IQR] 2-13 天,P=0.005),但死亡率在匹配前没有显著统计学差异(20.8% 对 15.5%,P=0.559)。经过 1:2 倾向评分匹配后,开放性骨折组的感染率明显更高(37.5% vs. 6.3%,P=0.002),而重症监护室住院时间(中位数 11 天,IQR 6-30 天 vs. 中位数 8 天,IQR 4-19 天;P=0.312)和死亡率(20.8% vs. 27.1%,P=0.564)则无明显差异。结论:开放式骨盆骨折组的感染率高于闭合式骨盆骨折组,但死亡率无明显差异。无论骨折类型如何,积极治疗骨盆骨折都很重要,而努力减少感染对开放性骨盆骨折很重要。
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引用次数: 0
A method of bedside urethrography before catheterization in pelvic trauma in Korea: a case report 韩国骨盆创伤患者导管插入术前的床旁尿道造影方法:病例报告
Pub Date : 2023-12-20 DOI: 10.20408/jti.2023.0047
Hojun Lee, Sung Yup Jeong, Kun-Ha Hwang
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引用次数: 0
Delayed union of a pediatric lunate fracture in the United Kingdom: a case report and a review of current concepts of non-scaphoid pediatric carpal fractures 英国小儿月骨骨折延迟愈合:病例报告和非肩胛骨小儿腕骨骨折现有概念综述
Pub Date : 2023-12-20 DOI: 10.20408/jti.2023.0038
Timothy P. Davis, Elizabeth Headon, Rebecca Morgan, Ashley I. Simpson
critical
严重
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引用次数: 0
One year of treating patients with open fractures of the lower extremity in a new military trauma center in Korea: a case series 韩国新成立的军事创伤中心治疗下肢开放性骨折患者一年的病例系列
Pub Date : 2023-12-19 DOI: 10.20408/jti.2023.0041
Ji Wool Ko, Giho Moon, Jin Geun Kwon, Kyoung Eun Kim, Hankaram Jeon, Kyungwon Lee
Purpose: The Armed Forces Trauma Center of Korea was established in April 2022. This study was conducted to report our 1-year experience of treating soldiers with open fractures of the lower extremity. Methods: In this case series, we reviewed the medical records of 51 Korean soldiers with open fractures of the lower extremity between April 2022 and March 2023 at a trauma center. We analyzed patients with Gustilo-Anderson type II and III fractures and reported the duration of transportation, injury mechanisms, injured sites, and associated injuries. We also presented laboratory findings, surgery types, intensive care unit stays, hospital stays, rehabilitation results, and reasons for psychiatric consultation. Additionally, we described patients’ mode of transport. Results: This study enrolled nine male patients who were between 21 and 26 years old. Six patients had type II and three had type III fractures. Transport from the accident scene to the emergency room ranged from 75 to 455 minutes, and from the emergency room to the operating room ranged from 35 to 200 minutes. Injury mechanisms included gunshot wounds, landmine explosions, gre-nade explosions, and entrapment by ship mooring ropes. One case had serious associated injuries (inhalation burn, open facial bone fractures, and hemopneumothorax). No cases with serious blood loss or coagulopathies were found, but most cases had a significant elevation of creatinine kinase. Two patients underwent vascular reconstruction, whereas four patients received flap surgery. After rehabilitation, six patients could walk, one patient could move their joints actively, and two patients performed active assistive movement. Eight patients were referred to the psychiatry department due to suicidal attempts and posttraumatic stress disorder. Conclusions: This study provides insights into how to improve treatment for patients with military trauma, as well as medical services such as the transport system, by revising treatment protocols and systematizing treatment.
目的:韩国武装部队创伤中心成立于 2022 年 4 月。本研究旨在报告我们治疗下肢开放性骨折士兵的 1 年经验。研究方法在本病例系列中,我们回顾了创伤中心 2022 年 4 月至 2023 年 3 月期间 51 名下肢开放性骨折韩国士兵的病历。我们对 Gustilo-Anderson II 型和 III 型骨折患者进行了分析,并报告了转运时间、受伤机制、受伤部位和相关损伤。我们还介绍了化验结果、手术类型、重症监护室停留时间、住院时间、康复结果以及精神科咨询的原因。此外,我们还描述了患者的交通方式。研究结果本研究共收治了 9 名男性患者,他们的年龄在 21 岁至 26 岁之间。六名患者为 II 型骨折,三名为 III 型骨折。从事故现场到急诊室的交通时间为 75 至 455 分钟,从急诊室到手术室的交通时间为 35 至 200 分钟。受伤机制包括枪伤、地雷爆炸、灰霾爆炸和被船舶系泊绳索缠绕。其中一例伴有严重损伤(吸入性烧伤、开放性面部骨折和血气胸)。没有发现严重失血或凝血功能障碍的病例,但大多数病例的肌酸激酶明显升高。两名患者接受了血管重建,四名患者接受了皮瓣手术。康复后,6 名患者可以行走,1 名患者可以主动活动关节,2 名患者可以进行主动辅助运动。八名患者因试图自杀和创伤后应激障碍而被转至精神科。研究结论这项研究为如何通过修订治疗方案和系统化治疗来改善军事创伤患者的治疗以及运输系统等医疗服务提供了启示。
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引用次数: 0
Bilateral distal femoral epiphyseal detachment in a young adult: a case report. 青年人双侧股骨远端骨骺脱离1例
Pub Date : 2023-12-01 Epub Date: 2023-08-25 DOI: 10.20408/jti.2023.0011
Armand Yepie, Moctar Traore, Mensah Yaovi, Michel Anoumou

Epiphyseal dislocations and fractures frequently occur in children and adolescents. However, these injuries seldom involve the distal femur, and bilateral cases are even rarer. We present an unusual case of bilateral epiphyseal detachment of the femur in a 21-year-old man who was involved in a traffic accident. Open reduction and fixation surgery were performed 5 days after the incident. The patient experienced favorable progress, with consolidation occurring at 3 months. No lower limb length discrepancies were observed at the 20-month follow-up. In summary, bilateral distal femoral epiphyseal detachment is an uncommon condition that can be effectively treated through surgical intervention.

儿童和青少年经常发生骨骺脱位和骨折。然而,这些损伤很少涉及股骨远端,双侧病例更为罕见。我们报告了一例不寻常的双侧股骨骨骺分离病例,该病例发生在一名21岁的交通事故中。事件发生后5天进行了切开复位和固定手术。患者进展良好,3个月时出现巩固。在20个月的随访中未观察到下肢长度差异。总之,双侧股骨远端骨骺脱离是一种罕见的情况,可以通过手术干预进行有效治疗。
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引用次数: 0
Free tissue transfer for reconstruction of axillary defects: two case reports. 游离组织移植重建腋窝缺损2例报告
Pub Date : 2023-12-01 Epub Date: 2023-08-25 DOI: 10.20408/jti.2023.0024
Asha Deepthi Bathini, Parvathi Ravula, Srinivas Jammula, Srikanth Rangachari, Priyanka Pereira

Axillary defects need pliable, vascular tissue to cover the critical structures traversing the axilla and to allow near-normal range of motion in the shoulder. Although local flaps are the first choice, free tissue transfer is a good option when local tissues are injured or scarred. Herein, we report two cases of axillary defects that were reconstructed using anterolateral thigh free flaps. One was a post-electric burn axillary defect for which a thoracoacromial pedicle was used as the recipient, and the other was a posttraumatic axillary defect with the transverse cervical vessels as the recipient. In both patients, the flap survived well with no complications and resulted in adequate functional recovery. In large defects of the axilla with a scarcity of local tissues, free flaps can yield optimal results. The proper selection of recipient vessels and a donor flap with adequate pedicle length impact the outcomes of such reconstruction.

供体
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引用次数: 0
Surgical management of supratentorial and infratentorial epidural hematoma in Korea: three case reports. 韩国硬膜上和硬膜下硬膜外血肿的手术治疗:三份病例报告。
Pub Date : 2023-12-01 Epub Date: 2023-12-26 DOI: 10.20408/jti.2023.0073
Su Young Yoon, Junepill Seok, Yook Kim, Jin Suk Lee, Jin Young Lee, Mou Seop Lee, Hong Rye Kim

Supratentorial and infratentorial epidural hematoma (SIEDH) is a rare but life-threatening complication following traumatic brain injury. However, the literature on SIEDH is sparse, consisting only of a few small series. Prompt diagnosis and the application of appropriate surgical techniques are crucial for the rapid and safe management of SIEDH. Herein, we present three cases of SIEDH treated at our institution, employing a range of surgical approaches.

硬膜上和硬膜下硬膜外血肿(SIEDH)是脑外伤后一种罕见但危及生命的并发症。然而,有关硬脑膜上和硬脑膜下血肿的文献很少,仅有几个小系列。及时诊断和应用适当的外科技术对于快速、安全地处理 SIEDH 至关重要。在此,我们介绍了本院采用多种手术方法治疗的三例 SIEDH 病例。
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引用次数: 0
Perceptions regarding the multidisciplinary treatment of patients with severe trauma in Korea: a survey of trauma specialists 对韩国多学科治疗严重创伤患者的看法:创伤专家调查
Pub Date : 2023-12-01 DOI: 10.20408/jti.2023.0045
Shin Ae Lee, Yeon Jin Joo, Ye Rim Chang
Purpose: Patients with multiple trauma necessitate assistance from a wide range of departments and professions for their successful reintegration into society. Historically, the primary focus of trauma treatment in Korea has been on reducing mortality rates. This study was conducted with the objective of evaluating the current state of multidisciplinary treatment for patients with severe trauma in Korea. Based on the insights of trauma specialists (i.e., medical professionals), we aim to suggest potential improvements. Methods: An online questionnaire was conducted among 871 surgical specialists who were members of the Korean Society of Traumatology. The questionnaire covered participant demographics, current multidisciplinary practices, perceived challenges in collaboration with rehabilitation, psychiatry, and anesthesiology departments, and the perceived necessity for multidisciplinary treat-ment. Results: Out of the 41 hospitals with which participants were affiliated, only nine conducted multi-disciplinary meetings or rounds with nonsurgical departments. The process of transferring patients to rehabilitation facilities was not widespread, and delays in these transfers were frequently observed. Financial constraints were identified by the respondents as a significant barrier to multidisciplinary collaboration. Despite these hurdles, the majority of respondents acknowledged the importance of multidisciplinary treatment, especially in relation to rehabilitation, psychiatry, and an-esthesiology involvement. Conclusions: This survey showed that medical staff specializing in trauma care perceive several issues stemming from the absence of a multidisciplinary system for patient-centered care in Korea. There is a need to develop an effective multidisciplinary treatment system to facilitate the recovery of trauma patients.
目的:多重创伤患者需要广泛的科室和专业的帮助才能成功地重新融入社会。从历史上看,韩国创伤治疗的主要重点一直是降低死亡率。本研究的目的是评估韩国严重创伤患者的多学科治疗现状。根据创伤专家(即医疗专业人员)的见解,我们旨在提出潜在的改进建议。方法:对871名韩国创伤学会外科专家进行在线问卷调查。调查问卷涵盖了参与者的人口统计、目前的多学科实践、与康复、精神病学和麻醉科合作的感知挑战,以及感知到多学科治疗的必要性。结果:在参与者所属的41家医院中,只有9家与非手术部门进行了多学科会议或查房。将患者转移到康复设施的过程并不普遍,并且经常观察到这些转移的延误。答复者认为,财政限制是多学科合作的一个重大障碍。尽管存在这些障碍,大多数受访者承认多学科治疗的重要性,特别是在康复、精神病学和美学参与方面。结论:这项调查显示,专门从事创伤护理的医务人员认为,由于韩国缺乏以患者为中心的多学科护理系统,因此存在一些问题。有必要发展一个有效的多学科治疗系统,以促进创伤患者的康复。
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引用次数: 0
Isolated penetrating gluteal stab injury with uncontrolled bleeding in Türkiye: a case report. 土耳其孤立性穿透性臀大肌刺伤出血失控1例报告
Pub Date : 2023-12-01 Epub Date: 2023-08-08 DOI: 10.20408/jti.2023.0010
Ali Metehan Celep, Görkem Yiğit, Ayla Ece Çelikten, Kudret Atakan Tekin, Ufuk Türkmen

Arterial injuries in the gluteal region caused by a knife are rare but serious, with mortality rates of up to 25%. This case report presents the management of a young male patient admitted to the emergency department in hypovolemic shock, with uncontrollable bleeding from an isolated penetrating gluteal injury. Additionally, the details of the surgical approach employed are discussed.

危及生命的疾病,包括内脏、血管、神经、臀下动脉和/或臀上动脉、髂动脉、坐骨神经、尿道、直肠和脊髓损伤。在延迟治疗的情况下,可能会发展为假性动脉瘤。观察到的死亡风险高达25%
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引用次数: 0
Successful nonoperative management of a simultaneous high-grade splenic injury and devascularized kidney in Australia: a case report. 澳大利亚同时发生高级别脾损伤和肾断流术的非手术治疗成功一例报告
Pub Date : 2023-12-01 Epub Date: 2023-09-07 DOI: 10.20408/jti.2023.0017
Peter Thanh Tam Nguyen, Jeremy M Hsu

Severe blunt injuries to isolated solid abdominal viscera have been previously managed nonoperatively; however, management algorithms for simultaneous visceral injuries are less well defined. We report a polytrauma case of a 33-year-old man involved in a motorbike collision who presented with left-sided chest and abdominal pain. Initial imaging demonstrated multiple solid organ injuries with American Association for the Surgery of Trauma (AAST) grade V splenic injury and complete devascularization of the left kidney. The patient underwent urgent angioembolic coiling of the distal splenic artery with successful nonoperative management of simultaneous grade V solid organ injuries.

,
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引用次数: 0
期刊
Journal of Trauma and Injury
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