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Conservative treatment of corpus callosum hemorrhage due to a falling coconut in Indonesia: a case report 印度尼西亚椰子坠落导致胼胝体出血的保守治疗:病例报告
Pub Date : 2024-01-12 DOI: 10.20408/jti.2023.0052
Hanan Anwar Rusidi, Ferry Wijanarko
The potential for traumatic brain injury resulting from falling coconuts is frequently overlooked. These incidents can cause focal lesions in the form of brain hemorrhage. Corpus callosum hemorrhage due to blunt trauma from a falling object is rare and typically associated with poor prognosis. The purpose of this report is to detail a case of corpus callosum hemorrhage caused by a coconut fall and to discuss the conservative management approach employed. We report the case of a 54-year-old woman who was admitted to the hospital with symptoms of unconsciousness, headache, and expressive aphasia after being struck by a falling coconut. Notably, hemorrhage was detected within the body of the corpus callosum, as revealed by imaging findings. The patient received intensive monitoring and treatment in the intensive care unit, including oxygen therapy, saline infusion, an osmotic diuretic, analgesics, and medication to prevent stress ulcers. The patient demonstrated marked clinical improvement while undergoing conservative treatment. Despite the typically unfavorable prognosis of these rare injuries, our patient exhibited meaningful clinical improvement with conservative treatment. Timely diagnosis and appropriate interventions were crucial in managing the patient’s condition. This report emphasizes the importance of considering traumatic brain injury caused by falling coconuts and highlights the need for further research and awareness in this area.
椰子坠落可能造成的脑外伤经常被忽视。这些事故可导致脑出血形式的局灶性病变。由高空坠物造成的钝性外伤导致的胼胝体出血非常罕见,通常预后较差。本报告旨在详细介绍一例椰子坠落导致的胼胝体出血病例,并讨论所采用的保守治疗方法。我们报告了一例 54 岁女性的病例,她在被坠落的椰子砸伤后因昏迷、头痛和表达性失语症状入院。值得注意的是,影像学检查结果显示,患者的胼胝体体内有出血。患者在重症监护室接受了强化监测和治疗,包括氧疗、生理盐水输注、渗透性利尿剂、镇痛剂和预防应激性溃疡的药物。在接受保守治疗的同时,患者的临床症状也得到了明显改善。尽管这种罕见损伤的预后通常不佳,但我们的患者在接受保守治疗后临床症状得到了明显改善。及时诊断和适当干预对控制患者病情至关重要。本报告强调了考虑椰子坠落造成的脑外伤的重要性,并强调了在这一领域开展进一步研究和提高认识的必要性。
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引用次数: 0
Usefulness of presepsin as a prognostic indicator for patients with trauma in the emergency department 前血蛋白作为急诊科创伤患者预后指标的实用性
Pub Date : 2024-01-12 DOI: 10.20408/jti.2023.0061
Si Woo Kim, Jung-Youn Kim, Y. Yoon, Sung Joon Park, Bosun Shim
Purpose: Trauma is an important public health concern, and it is important to increase the survival rate of patients with trauma and enable them to return to society in a better condition. Initial treat-ment in the emergency department (ED) is closely associated with the prognosis of patients with trauma. However, studies regarding laboratory biomarker tests that can help predict the prognosis of trauma patients are limited. Presepsin is a novel biomarker of inflammation that can predict a poor prognosis in patients with sepsis. This study aimed to determine whether presepsin could be used as a prognostic indicator in patients with polytrauma. Methods: The study included patients with trauma who had visited a single regional ED from November 2021 to January 2023. Patients who had laboratory tests in the ED were included and analyzed retrospectively through chart review. Age, sex, injury mechanism, vital signs, surgery, the outcome of ED treatment (admission, discharge, transfer, or death), and trauma scores were analyzed. Results: Overall, 550 trauma patients were enrolled; 59.1% were men, and the median age was 64 years (interquartile range, 48.8–79.0 years). Patients in a hypotensive state (systolic blood pressure, <90 mmHg; n=39) had higher presepsin levels (1,061.5±2,522.7 pg/mL) than those in a nonhypoten-sive state (n=511, 545.7±688.4 pg/mL, P<0.001). Patients hospitalized after ED treatment had the highest presepsin levels (660.9 pg/mL), followed by those who died (652.0 pg/ mL), were transferred to other hospitals (514.9 pg/mL), and returned home (448.0 pg/mL, P=0.041). Conclusions: Serum presepsin levels were significantly higher in trauma patients in a hypotensive state than in those in a nonhypotensive state. Additionally, serum presepsin levels were the highest in hospitalized patients with trauma, followed by those who died, were transferred to other hospitals, and returned home.
目的:创伤是一个重要的公共卫生问题,提高创伤患者的存活率并使他们以更好的状态重返社会非常重要。急诊科(ED)的初步治疗与创伤患者的预后密切相关。然而,有关有助于预测创伤患者预后的实验室生物标志物检测的研究却很有限。前血蛋白是一种新型炎症生物标志物,可预测败血症患者的不良预后。本研究旨在确定前血蛋白是否可用作多发性创伤患者的预后指标。研究方法研究对象包括 2021 年 11 月至 2023 年 1 月期间在单一地区急诊室就诊的创伤患者。研究纳入了在急诊室进行实验室检测的患者,并通过病历回顾进行了回顾性分析。研究分析了患者的年龄、性别、受伤机制、生命体征、手术情况、急诊室治疗结果(入院、出院、转院或死亡)以及创伤评分。结果:共有 550 名外伤患者,59.1% 为男性,中位年龄为 64 岁(四分位数范围为 48.8-79.0 岁)。处于低血压状态的患者(收缩压<90 mmHg;n=39)的前体蛋白水平(1,061.5±2,522.7 pg/mL)高于非低血压状态的患者(n=511,545.7±688.4 pg/mL,P<0.001)。ED 治疗后住院的患者前体素水平最高(660.9 pg/mL),其次是死亡患者(652.0 pg/mL)、转院患者(514.9 pg/mL)和回家患者(448.0 pg/mL,P=0.041)。结论低血压状态下的创伤患者血清前体素水平明显高于非低血压状态下的患者。此外,住院创伤患者的血清前体素水平最高,其次是死亡、转院和回家的患者。
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引用次数: 0
Emergency department laparotomy for patients with severe abdominal trauma: a retrospective study at a single regional trauma center in Korea 急诊科对严重腹部创伤患者的开腹手术:韩国一家地区创伤中心的回顾性研究
Pub Date : 2024-01-12 DOI: 10.20408/jti.2023.0072
Yu Jin Lee, Soon Tak Jeong, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Kyounghwan Kim, Sungjin Park, Jihun Gwak, Wu Seong Kang
Purpose: Severe abdominal injuries often require immediate clinical assessment and surgical intervention to prevent life-threatening complications. In Jeju Regional Trauma Center, we have instituted a protocol for emergency department (ED) laparotomy at the trauma bay. We investigated the mortality and time taken from admission to ED laparotomy. Methods: We reviewed the data recorded in our center’s trauma database between January 2020 and December 2022 and identified patients who underwent laparotomy because of abdominal trauma. Laparotomies that were performed at the trauma bay or the ED were classified as ED laparotomy, whereas those performed in the operating room (OR) were referred to as OR laparotomy. In cases that required expeditious hemostasis, ED laparotomy was performed appropriately. Results: From January 2020 to December 2022, 105 trauma patients admitted to our hospital underwent emergency laparotomy. Of these patients, six (5.7%) underwent ED laparotomy. ED laparotomy was associated with a mortality rate of 66.7% (four of six patients), which was significantly higher than that of OR laparotomy (17.1%, 18 of 99 patients, P=0.006). All the patients who received ED laparotomy also underwent damage control laparotomy. The time between admission to the first laparotomy was significantly shorter in the ED laparotomy group (28.5 minutes; interquartile range [IQR], 14–59 minutes) when compared with the OR laparotomy group (104 minutes; IQR, 88–151 minutes; P<0.001). The two patients who survived after ED laparotomy had massive mesenteric bleeding, which was successfully ligated. The other four patients, who had liver laceration, kidney rupture, spleen injury, and pancreas avulsion, succumbed to the injuries. Conclusions: Although ED laparotomy was associated with a higher mortality rate, the time be-tween admission and ED laparotomy was markedly shorter than for OR laparotomy. Notably, major mesenteric hemorrhages were effectively controlled through ED laparotomy.
目的:严重的腹部损伤往往需要立即进行临床评估和手术干预,以防止出现危及生命的并发症。在济州地区创伤中心,我们制定了在创伤室进行急诊科(ED)开腹手术的方案。我们对死亡率和从入院到急诊科开腹手术所需的时间进行了调查。方法:我们回顾了本中心创伤数据库在 2020 年 1 月至 2022 年 12 月期间记录的数据,并确定了因腹部创伤而接受开腹手术的患者。在创伤室或急诊室进行的开腹手术被归类为急诊室开腹手术,而在手术室(OR)进行的开腹手术被称为手术室开腹手术。在需要快速止血的病例中,急诊室开腹手术被恰当地执行。结果:2020 年 1 月至 2022 年 12 月,我院收治的 105 名创伤患者接受了急诊开腹手术。其中,6 名患者(5.7%)接受了急诊开腹手术。急诊室开腹手术的死亡率为66.7%(6名患者中有4名),明显高于手术室开腹手术的死亡率(17.1%,99名患者中有18名,P=0.006)。所有接受急诊室开腹手术的患者都接受了损伤控制开腹手术。与手术室开腹手术组(104 分钟;IQR,88-151 分钟;P<0.001)相比,急诊室开腹手术组从入院到首次开腹手术的时间明显更短(28.5 分钟;四分位数间距 [IQR],14-59 分钟)。在急诊室开腹手术后存活的两名患者肠系膜大量出血,并成功结扎。另外四名患者则因肝裂伤、肾破裂、脾损伤和胰腺撕脱而死亡。结论虽然急诊室开腹手术的死亡率较高,但入院到急诊室开腹手术之间的时间明显短于手术室开腹手术。值得注意的是,肠系膜大出血可通过急诊室开腹手术得到有效控制。
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引用次数: 0
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
{"title":"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","authors":"Timothy P. Davis, Elizabeth Headon, Rebecca Morgan, Ashley I. Simpson","doi":"10.20408/jti.2023.0038","DOIUrl":"https://doi.org/10.20408/jti.2023.0038","url":null,"abstract":"critical","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":"504 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139170462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
期刊
Journal of Trauma and Injury
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