• Archives of Reconstructive Microsurgery
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• 제22권2호
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• pp.78-81
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• 2013

Neurofibroma may present as a solitary lesion or as multiple lesions. Although there is no site of predilection for solitary lesions, occurrence on the hand is rare. Plexiform neurofibroma can develop in isolation or more commonly as a part of neurofibromatosis type 1. In those that apper in isolation, trauma has been suggested as a precipitating factor. A 68-year-old male farmer had experienced repetitive prior episodes of trauma in the involved finger. He presented with a painless mass on the dorsal aspect of the fifth finger. Physical examination showed a protruding mass measuring approximately $15{\times}20mm$ which was not tenderness to palpation and any skin changes or pigmentation. Ultrasonography showed a cystic mass on the dorsal aspect of the middle phalanx. Microsurgical dissection was applied in order to seperated the lesion from the ulnar side of the dorsal branch of the digital nerve. Pathologic examination of the specimens revealed neurofibroma. At three-month follow-up, motor and sensory function were intact, and range of motion was fully recovered. Traumatic solitary neurofibroma is a rare tumor of the hand, especially in the finger. Hand surgeons should be aware of the diagnostic possibilities of this tumor based on examination, history taking and imaging studies.

• 대한치과의사협회지
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• 제51권8호
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• pp.442-450
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• 2013

It is well known that the majority of dental injuries occur in children and adolescent. An injury to the teeth can have serious and long-term consequences, leading to their discoloration, malformation, or possible loss. The emotional impact of such an injury can be far reaching. The majority of dental injuries in the primary and permanent dentitions involve the anterior teeth, especially the maxillary central incisors. Concussion, subluxation, and luxation are the commonest injuries in the primary dentition, while uncomplicated crown fractures are commonest in the permanent dentition. If it is decided to preserve a traumatized primary tooth, it should be carefully observed for clinical and radiographic signs of pulpal or periodontal complications. Radiographs are also examined closely to disclose any damage to the permanent successor. The intervals between reexaminations should be individualized depending on the severity of trauma, the expected type of complications and the age of the patient. Most complications are observed within the first year of the trauma. However, the follow-up evaluation of permanent teeth should continue until treatment of all complications is completed, or until a lost or extracted permanent tooth has been adequately replaced. It is important that the dentist and the other members of the dental team are well prepared to meet the many complex and challenging problems in the care of dental emergencies.

• Archives of Reconstructive Microsurgery
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• 제17권1호
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• pp.7-13
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• 2008

Popliteal artery injury in blunt trauma of knee joint is not common but poses high rate of amputation due to anatomical characteristics or delayed diagnosis and treatment. The aim of the present study is to review the authors' experiences with this condition and identify factors contributing to disability. We reviewed 7 cases of popliteal artery injury in trauma around knee. Injury mechanism, type of vessel damage, associated injuries, mangled extremity severity scores (MESS), ischemic time and additional treatments were analyzed. Tibial fracture, distal femoral fracture and serious soft tissue defect were combined. Mean MESS was 9.9 point and mean time of revascularization was 7.1 hours. Transfemoral amputation was performed in 2 cases due to vascular insufficiency and devastating infection, and 4 patients were able to walk without any support at the last follow up. Age, the severity of soft tissue injury, ischemic time and MESS are thought to be related to prognosis, and young patients with short ischemic time show best results, but authors experienced one exceptional case. We have to consider multiple factors related to the prognosis in popliteal artery injury with fractures around knee, and careful decision is needed regarding to early amputation.

• Clinics in Shoulder and Elbow
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• 제23권3호
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• pp.131-135
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• 2020

Background: Resection of the radial head is a surgical indication for comminuted radial head fracture in which internal fixation is inaccessible. Some complications from the surgery can alter the function of the patient's elbow. The objective of this study was to assess functional outcome of the elbow after resection of the radial head. Methods: A retrospective longitudinal study was performed with patients who underwent radial head resection between 2008 and 2018. Elbow function was assessed by the Mayo Elbow Performance Index (MEPI) for 11 patients comprising three women and eight men. The mean follow-up was 47.6 months. The mean age was 41±10.3 years. Results: Nine patients had a stable and painless elbow. The mean extension-flexion arc was 97.73°±16.03°. The mean values of pronation and supination were 76.8° and 74.5°, respectively. The mean MEPI score was 83.2 points, and restoration of overall function was achieved in 81% of the cases. Poor function was noted in one in 10 that presented with a terrible triad. Conclusions: Resection of the radial head restored elbow functionality at a rate of 81%, which was a good outcome for patients.

• Journal of Trauma and Injury
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• 제24권1호
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• pp.25-30
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• 2011

Purpose: Major trauma patients should be transferred to a definitive care facility as early as possible because prompt management will prevent death. This study was designed to discover the obstacles leading to delayed transfers under the current emergency medical system in Korea and whether there are any negative outcomes associated with conducting procedures at primary care hospitals prior to transferring patients to higher levels of care. Methods: The medical records of major trauma patients with an Injury Severity Score above 15 within the past year were reviewed. Patients were divided three groups as follows: (A) came directly to our emergency center, (B) were transferred without CT or MRI scan at the primary care hospital and (C) transferred with CT or MRI scans. The transfer time of each group were compared and analyzed statistically. Additionally, the number and type of imaging performed at the primary care hospital were analyzed. Results: All qualified patients (n=276) were enrolled in this study: 121 patients in group A; 104 in group B; 51 in group C. There was a statistically significant difference in the transfer time between the three groups (p-value<0.001), and 79 (28.6%) were transferred to an emergency medical center within one hour. In group C, CT or MRI scans were performed an average of 1.86 times at the primary care hospital, and the median transfer time was 4 hours 5 minutes. Conclusion: Only 28.6% of the cases in the study arrived within the golden hour at a definitive care facility. Such delays are in part the result of prolonged times at the primary care hospital for radiologic examinations, such as CT or MRI scans. Major multiple trauma patients should be transferred to a definitive care facility directly or as soon as the primary survey and the resuscitation of Advanced Trauma Life Support guideline are completed at the primary care hospital.

• 대한토목학회논문집
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• 제43권1호
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• pp.119-129
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• 2023

자연재해는 지역사회 전반에 극심한 스트레스를 발생시킨다. 다수의 경우 시간의 흐름에 따라 충격을 극복하지만, 일부는 PTSD와 같은 장기적인 정신적 피해를 경험하게 된다. 이에 재난과 심리적 충격에 관한 연구가 진행되고 있지만, 여전히 부족한 수준이다. 자연재해는 시설 붕괴, 인명피해 등 다양한 피해를 야기하기에 피해자가 경험하는 피해의 종류가 다르며, 경험하는 상실의 정도에도 차등이 있다. 특히 자연재해로 인한 가장 흔한 피해인 주택파손의 경우 피해자가 경험하는 충격은 매우 크다. 따라서 본 연구는 자연재해로 주택이 파손된 가구가 경험하는 심리적 충격을 확인하고, 추적연구를 통해 심리적 충격이 변화하는 특성을 확인하고자 하였다. 연구 결과, 주택이 파손된 경우 심리적 충격이 더 크게 나타나 주택의 파손으로 인한 심리적 충격이 다른 피해로 인한 충격보다 더 큰 것을 확인했다. 또, 재난으로 인해 발생하는 심리적 충격이라고 할지라도 불안, 우울, PTSD 그리고 전반적인 심리적 충격 등 그 성격에 따라 변화 양상에 영향을 미치는 요인이 다른 것으로 나타났다. 그 중, 보건의료 서비스는 모든 변수에서 유의하게 분석돼 재난 이후 안전과 관련된 기본서비스의 제공이 가장 필요로 된다고 해석된다. 또, 재난구호서비스 중 심리 안정 지원은 불안, 우울과 같은 단기적인 충격에는 긍정적인 영향을 미치나, 심리적 영향이 가중된 PTSD에서는 오히려 역효과를 보여 심리지원체계의 변화 및 발전이 요구된다고 할 수 있다.

• Hip & pelvis
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• 제34권1호
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• pp.18-24
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• 2022

Purpose: The aim of this study was to determine whether there is a correlation between the type and stability of intertrochanteric fractures caused by low-energy trauma and gluteus muscle volume. Materials and Methods: A total of 205 elderly (>65 years) patients with intertrochanteric fractures caused by low-energy trauma treated from January 2018 to December 2020 were included in this study. The mean age of patients was 81.24 years (range, 65-100 years). Fractures were classified according to the Jensen modification of the Evans classification. The cross-sectional area of the contralateral gluteus muscle (minimus, medius, and maximus) was measured in preoperative axial computed tomography slices. An analysis and comparison of age, body mass index (BMI), weight, height, and the gluteus muscle area in each fracture type group was performed. Results: In the uni-variable analysis, statistically significant taller height was observed in patients in the stable intertrochanteric fracture (modified Evans 1 and 2) group compared with those in the unstable intertrochanteric fracture (modified Evans 3, 4, and 5) group (P<0.05). In addition, significantly higher BMI-adjusted gluteus muscle area (gluteus muscle area/BMI) was observed for the stable intertrochanteric fracture group compared with the unstable intertrochanteric fracture group except for the BMI-adjusted gluteus minimus area (P=0.112). In multivariable analysis, only the BMI-adjusted gluteus maximus (P=0.042) and total gluteus areas (P=0.035) were significantly higher in the stable group. Conclusion: Gluteal muscularity around the hip, especially the gluteus maximus, had a significant effect on the stability of intertrochanteric fractures.

• Journal of Trauma and Injury
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• 제32권2호
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• pp.101-106
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• 2019

Purpose: The purpose of this study was to determine the essential factors for prompt arrangement of angio-embolization in patients with pelvic ring fractures. Methods: A total of 62 patients with pelvic ring fractures who underwent angio-embolization in Dankook University Hospital from March 2013 to June 2018 were retrospectively reviewed. There were 38 men and 24 women with a mean age of 59.8 years. The types of pelvic ring fractures were categorized according to the Tile classification. Patient variables included sex, initial hemoglobin concentration, initial systolic blood pressure, transfused packed red blood cells within 24 hours, Injury Severity Score (ISS), mortality rate, length of hospital stay, and time to angio-embolization. Results: The most common pelvic fracture pattern was Tile type B (n=34, 54.8%). The mean ISS was $27.3{\pm}10.9$ with 50% having an $ISS{\geq}25$. The mean time to angio-embolization from arrival was $173.6{\pm}89minutes$. Type B ($180.1{\pm}72.3minutes$) and type C fractures ($174.7{\pm}91.3minutes$) required more time to angio-embolization than type A fractures ($156.6{\pm}123minutes$). True arterial bleeding was identified in types A (35.7%), B (64.7%), and C (71.4%). Conclusions: It is important to save time to reach the angio-embolization room in treating patients with pelvic bone fractures. Trauma surgeons need to consider prompt arrangement of angio-embolization when encountering Tile type B or C pelvic fractures due to the high risk of true arterial bleeding.

• Journal of Trauma and Injury
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• 제32권4호
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• pp.195-201
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• 2019

Purpose: This study was conducted to investigate the usefulness of a polyester urethane dural substitute (Neuro-Patch^®, B. Braun, Boulogne, France) as an anti-adhesion agent in subsequent cranioplasty by analyzing the use of Neuro-Patch^® during decompressive craniectomy in traumatic brain injury patients. Methods: We retrospectively analyzed patients with traumatic brain injury who underwent decompressive craniectomy followed by cranioplasty from January 2015 to December 2018. Patients were analyzed according to whether they received treatment with Neuro-Patch^® or not (Neuro-Patch^® group, n=71; control group, n=55). Patients' baseline characteristics were analyzed to identify factors that could affect cranioplasty results, including age, sex, hypertension, diabetes mellitus, use of antiplatelet agents or anticoagulant medication, the interval between craniectomy and cranioplasty, and the type of bone used in cranioplasty. The cranioplasty results were analyzed according to the following factors: operation time, blood loss, postoperative hospitalization period, surgical site infection, and revision surgery due to extra-axial hematoma. Results: No significant difference was found between the two groups regarding patients' baseline characteristics. For the cranioplasty procedures, the operation time (155 vs. 190 minutes, p=0.003), intraoperative blood loss (350 vs. 450 mL, p=0.012), and number of surgical site infections (4 vs. 11 cases, p=0.024) were significantly lower in the Neuro-Patch^® group than in the control group. Conclusions: The use of Neuro-Patch^® was associated with a shorter operation time, less blood loss, and a lower number of surgical site infections in subsequent cranioplasties. These results may provide a rationale for prospective studies investigating the efficacy of Neuro-Patch^®.

• Journal of Trauma and Injury
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• 제28권4호
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• pp.284-291
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• 2015

The aim of this study is to present a nonoperative treatment for abdominal injuries in patients with multiple traumas and to discuss the role of metropolitan tertiary hospital, non-regional trauma centers. We collected data from patients with multiple traumas including abdominal injuries from 2009 to 2014. Patient characteristics, associated injuries, short-term outcomes and departments that managed the patients overall were analyzed. Based on treatment modalities for abdominal injury, patients were divided into two groups: the operative treatment group and the nonoperative treatment group. We compared differences in patient characteristics, injury mechanisms, initial vital signs, detailed injury types, lengths of hospital and ICU stays. Of the 167 patients with multiple traumas, abdominal injuries were found in 57 patients. The injury mechanism for 44 patients (77.2%) was traffic accidents, and associated extra-abdominal injuries were shown in 45 patients (78.9%). The mean lengths of hospital and ICU stays for the 57 patients were 36.4 days and 8.3 days, respectively. The in-hospital mortality rate was 8.8%. Ten patients (17.5%) were treated operatively, and 47 patients (82.5%) were treated nonoperatively. Among the 47 patients in the nonoperative treatment group, 17 patients received embolization, and 3 patients underwent a percutaneous drainage procedure. Operative treatments were used more in patients with injuries to the pancreas and bowel. No patient required additional surgery or died due to the failure of nonoperative treatment. No differences in the clinical characteristics except for the detailed injury type were observed between the two groups. In appropriately selected patients with multiple traumas including abdominal injuries, nonoperative treatment is a safe and feasible. For rapid and accurate managements of these patients, well-trained trauma surgeons who can manage problems with the various systems in the human body and who can decide whether nonoperative treatment is appropriate or not are required.