Journal of Trauma and Injury最新文献

Fat embolism syndrome (FES) is a rare but serious complication most commonly associated with trauma, particularly long bone fractures. However, symptomatic FES remains a significant diagnostic and therapeutic challenge. We present the case of a 20-year-old man who, after sustaining multiple long bone fractures in a motorcycle accident and initially appearing stable, experienced a rapid and fatal progression of FES. This case underscores the unpredictable course of FES even in young, previously healthy individuals and highlights the critical need for early recognition and intervention. It also emphasizes the importance of identifying risk factors that may predict severe outcomes and mortality.

Pelvic fractures result from high-energy trauma, and when accompanied by hemorrhagic shock, the mortality rate increases to 40%. Pelvic fractures are anatomically categorized as pelvic ring disruptions and acetabular fractures, each requiring different treatment methods and approaches. Acetabular fractures, which also result from high-energy injuries, may be accompanied by hemorrhagic shock. Treatment options for pelvic fractures with hemorrhagic shock include angioembolization, preperitoneal pelvic packing (PPP), and emergency laparotomy. In hemodynamically stable patients, early total care may be attempted, and for acetabular fractures (posterior column), the Kocher-Langenbeck approach is the treatment of choice. This case report describes the use of PPP as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability following a Kocher-Langenbeck approach for an acetabular fracture with pelvic ring injury. The patient was discharged without postoperative complications such as bone displacement or surgical site infection. While PPP is commonly employed as an initial treatment modality for pelvic fractures with hemorrhagic shock, it may also be valuable in managing postoperative retroperitoneal bleeding with hemorrhagic shock.

Inferior vena cava (IVC) injuries are rare but deadly. Depending on the mechanism of injury, patient status, and type of injury, intervention may be surgical or endovascular. These injuries typically pose challenges in identification and treatment. During surgical intervention, rapid access and timely control of the bleeding site may be difficult. In this series, we aim to describe various IVC injuries presented at our center, detailing challenges and outcomes in their management. The study aims to characterize the presentation, interventions, and outcomes of IVC injury cases at a level I trauma center over a period of 30 months. In this report, a total of six cases of IVC injury were treated at our center. All patients underwent surgical intervention. Each patient experienced a high-energy trauma mechanism, with three patients sustaining blunt trauma and three sustaining penetrating trauma. Of the six patients, three survived while three died. Mortality was attributed to delayed presentation, complexity of injuries, and technical difficulties. Adherence to Advanced Trauma Life Support (ATLS) protocols, timely diagnosis and resuscitation, and rapid decision-making can reduce mortality associated with IVC injuries. Nonetheless, surgeons must remain cognizant of the inherent challenges and pitfalls in managing these injuries.

Femoral neck fractures commonly occur in older patients and typically require surgical intervention to promptly restore mobility and minimize complications. While the anterior, lateral, and posterior approaches are frequently employed for hemiarthroplasty, each has its own benefits and drawbacks. Notably, the posterior approach has been linked to a higher risk of dislocation in some studies. The SPAIRE (saving piriformis and internus, repair of externus) technique is a modern adaptation of the traditional posterolateral approach. This less invasive, anatomically considerate method preserves the piriformis muscle tendon and the conjoint tendon of the superior gemellus, obturator internus, and inferior gemellus muscles. However, it involves sectioning the tendon of the obturator externus muscle. The technique is designed to maintain stabilizing muscular structures, decrease dislocation risk, and hasten functional recovery, including in patients with neurological conditions. This case report describes the treatment of a 79-year-old woman with a transcervical fracture of the right femoral neck. A bipolar hemiarthroplasty was performed using the SPAIRE technique. The procedure effectively preserved the functional synergistic unit of the piriformis-conjoint tendon (quadriceps coxa) and included meticulous capsular and tendinous repair. The patient's postoperative recovery was characterized by an excellent functional outcome at the 3-month follow-up. This case highlights the advantages of the SPAIRE technique in enhancing joint stability and facilitating rapid recovery, especially in geriatric patients.

Purpose: This study aimed to compare and analyze the effectiveness of near-cortex-only drilling for the surgical treatment of distal radius fractures using a volar locking plate.

Methods: From January 2010 to December 2022, a total of 185 patients aged 60 years or older with AO type C distal radius fractures who were treated with a volar locking plate at our hospital were enrolled. Of these, 59 patients were excluded according to the study criteria, resulting in a final cohort of 126 subjects. Without differentiating between left and right sides, group A (n=60) underwent distal locking screw fixation with screws of 12-mm length (except for the most radial screw) using near-cortex-only drilling. In group B (n=66), drilling was performed through to the dorsal cortex, and the length was measured using a depth gauge; distal screws were then fixed at a length 2 mm shorter than the measured depth. The degree of fracture reduction on postoperative radiographs was assessed using the modified Lidstrom scoring system by measuring radial inclination, radial height, and volar tilt. In addition, the visual analog scale, the Korean Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the incidence of extensor tendon rupture and tenosynovitis were evaluated at the final follow-up and compared between groups.

Results: Bone union was achieved in all cases, with no significant radiographic differences observed between the two groups (P>0.05). In contrast, two cases of extensor tenosynovitis were noted in group A, whereas group B experienced one extensor tendon rupture and five cases of extensor tenosynovitis, representing a significant difference (P<0.05).

Conclusions: In patients aged 60 years or older with AO type C distal radius fractures, the technique of near-cortex-only drilling with short distal locking screws yielded satisfactory results for fracture reduction and clinical indices. This approach may offer a new alternative for preventing extensor tendon rupture or tenosynovitis.

Despite the increasing incidence of vertebral artery injury (VAI), it can often be overlooked during the management of polytrauma patients. Due to its specific anatomical location, the VA is particularly susceptible to both traumatic and spontaneous injuries. Traumatic VAI can result from blunt or penetrating trauma and is frequently associated with cervical spine injuries. An 18-year-old male patient was brought to the emergency department after being struck by a motor vehicle. The patient exhibited altered mental status while remaining normotensive and tachypneic. Notably, there were no visible injuries to the head or neck, though multiple contusions were present on the chest and abdomen. Radiographic imaging revealed a fracture of the transverse process of the seventh cervical vertebra, which caused dissection, thrombosis, and occlusion of the V1 segment of the left VA. Additionally, hypoplasia of the contralateral VA was observed. Given the presence of ultrasonographically confirmed free intra-abdominal fluid and the patient's newly developed hemodynamic instability, he was urgently transferred to the operating theatre. A grade 3 liver laceration was discovered, and hemostasis was successfully achieved using direct sutures. After regaining consciousness, the patient reported right-sided homonymous hemianopsia accompanied by signs of cerebral ischemia. Following stabilization, he was started on anticoagulant and antiplatelet therapy. Upon discharge and during follow-up, the visual deficit persisted. This case emphasizes the importance of recognizing and managing VAI in polytraumatized patients. Furthermore, the rare combination of contralateral VA hypoplasia and VAI significantly influenced the development of neurological deficits.

This article describes the characteristics and management of injuries associated with ricochet effects due to portable charger detonation. We present a case series of four military personnel who sustained complex soft tissue injuries when portable chargers detonated after being struck by projectiles during combat. All patients were treated by an advanced surgical team at the Military Medical Clinical Center of the Northern Region in Kharkiv, Ukraine, over a 9-month period in 2023. Patient history, physical examination findings, laboratory studies, radiographic imaging, treatment approaches, and early outcomes were examined. All patients were male, with a mean age of 33±0.3 years. Complex soft tissue injury patterns arose when a projectile (such as a bullet or shrapnel) struck the charger, causing ricochet effects while damaging the battery housing and triggering detonation. The anatomical region of injury corresponded to the charger's placement in the patients' pockets, namely the thigh or buttock. Characteristic findings included local chemical burns of the skin and subcutaneous tissue, with surrounding ecchymosis. Surgical teams identified three zones of damage associated with this injury pattern: (1) a central zone with the most pronounced burn related changes, covering the smallest area of the three zones; (2) an intermediate zone of soft tissue damage from thermochemical reactions extending beyond the charger's profile; and (3) an outer zone of ecchymosis. Risks associated with carrying portable chargers during combat have not been well documented. These findings may inform injury prevention strategies for military personnel.

Purpose: Managing complex distal femur fractures presents technical challenges. Although the lateral locked plate has become standard for these fractures, failures are not uncommon when this device is used alone. Patients with nonunion of distal femur fractures following treatment with a single lateral locked plate were examined. Revision surgery was performed by applying dual plates, and their efficiency was evaluated.

Methods: This study investigated 24 aseptic and 3 septic nonunions of distal femur fractures, classified as AO/OTA type C, that were previously managed with open reduction and internal fixation using only a lateral locked plate. Revision surgery involved replacing the broken 5.0-mm lateral locked plate, supplementing the medial side with a 4.5-mm T-plate, and applying bone grafting at the fracture site. Septic cases were managed using a staged approach with dual implant application.

Results: Following revision surgery, bony union was achieved in 83.3% of aseptic nonunions, with a mean bone healing time of 22.5 weeks (range, 15-27 weeks). Additional surgery was required for the remaining 16.6%. Using staged management, the septic nonunions were united in a mean of 30.25 weeks (range, 27-32 weeks). Significant improvements were noted in the Tegner Lysholm Knee Scoring Scale, with median preoperative and postoperative scores of 30 (range, 12-67) and 80 (range, 66-90), respectively (P<0.001). Limb pain, as measured by the visual analog scale for knee pain, improved significantly from a preoperative median of 6 (range, 4-8) to 3 (range, 1-6) postoperatively (P<0.001). All patients were ambulatory without supportive devices. However, the mean knee range of motion was 80° (range, 40°-120°). Limb shortening was observed in six cases (22.2%; average shortening, 2.3±1.0 cm).

Conclusions: Dual plating appears to be an effective approach for managing failed complex distal femur fractures following initial treatment with a single lateral locked plate.

Surgical site infections (SSIs) represent a major public health challenge, contributing to increased morbidity, mortality, and healthcare costs worldwide. This paper presents a comprehensive review of the epidemiology, classification, risk factors, microbiological aspects, treatment modalities, and prevention strategies for SSIs, based on contemporary research and evidence-based practice protocols. An extensive literature review was conducted, synthesizing existing studies on SSIs. A comprehensive search was performed in PubMed, Embase, Cochrane Library, and guidelines from leading organizations such as the American College of Surgeons, the US Centers for Disease Control and Prevention, the World Health Organization, and the Infectious Diseases Society of America. Inclusion criteria encompassed peer-reviewed articles as well as American and European medical guidelines focusing on the epidemiology, risk factors, microbiology, treatment, and prevention of SSIs. The review adhered to the PECO (population, exposure, comparator, outcome) framework. Some of the most significant global concerns related to SSIs include antibiotic resistance and the contamination of surgical instruments, particularly in resource-poor settings. Trauma patients, especially those undergoing emergency procedures or sustaining open fractures, are at increased risk for SSIs due to the severity of their injuries and higher contamination risks. These findings underscore the importance of preventive measures, such as appropriate preoperative interventions, strict aseptic techniques, and proper antibiotic prophylaxis, in reducing SSI incidence and improving patient outcomes.

Purpose: Blunt traumatic aortic injuries (TAIs) require timely surgical intervention to prevent death. We described the management and outcomes of polytrauma patients with TAI after open and endovascular repair in Western Australia.

Methods: We performed a retrospective cohort study of patients with TAI admitted to the State Trauma Unit, Royal Perth Hospital from 2008 to 2018. Patient data were obtained from the Trauma Database and supplemented with chart review.

Results: Among 57 patients with TAI, 45 (78.9%) were male, with a mean age of 41 years, and were mainly involved in motor vehicle crashes (89.5%). They had a median Injury Severity Score of 34 (interquartile range [IQR], 21-45) and a median length of stay of 18 days. Concurrent injuries occurred in nearly all patients, including musculoskeletal (56 patients, 98.2%; mainly fractures, 91.2%), central nervous system (33 patients, 57.9%; mostly hemorrhage), injury to the chest cavity (46 patients, 80.7%), and abdominal organs (32 patients, 56.1%). The most common TAI grade was III (56.1%), followed by grade I (22.8%) and grade II (21.1%); all grade IV patients died before vascular consultation. TAI was managed with endovascular surgery (thoracic endovascular aortic repair, TEVAR) in 37 (64.9%, of which early TEVAR was performed in 29 [78.4%]), open surgery in 4 (7.0%), and conservative management in 16 (28.1%). Vascular procedures had a median duration of 81 minutes (IQR, 60-97 minutes). Acute vascular surgery-related complications were infrequent (5.3%), and all occurred post-TEVAR, mainly involving upper limb ischemia that required bypass or stenting within 72 hours of the index procedure. After discharge (52 patients), 3 patients were lost to follow-up regarding surgical survival, and late complications occurred in 6 of 48 vascular surgery patients (12.5%), who all underwent TEVAR.

Conclusions: TAI patients who received a vascular surgery review and were managed either conservatively or surgically showed favorable postdischarge survival rates and surgical results. Patients with grade II or III TAI who underwent endovascular repair had favorable short- and long-term outcomes.