Distribution of Trauma Deaths in a Province of Korea: Is “Trimodal” Distribution Relevant Today?

PURPOSE: This study was designed to provide a basis for building a master plan for a regional trauma system by analyzing the distribution of trauma deaths in the most populous province in Korea.MATERIALS AND METHODS: We investigated the time distribution to death for trauma patients who died between January and December 2017. The time distribution to death was categorized into four groups (within a day, within a week, within a month, and over a month). Additionally, the distribution of deaths within 24 hours was further analyzed. We also reviewed the distribution of deaths according to the cause of death and mechanism of injury.RESULTS: Of the 1546 trauma deaths, 328 cases were included in the final study population. Patients who died within a day were the most prevalent (40.9%). Of those who died within a day, the cases within an hour accounted for 40.3% of the highest proportion. The majority of trauma deaths within 4 hours were caused by traffic-related accidents (60.4%). The deaths caused by bleeding and central nervous system injuries accounted for most (70.1%) of the early deaths, whereas multi-organ dysfunction syndrome/sepsis had the highest ratio (69.7%) in the late deaths. Statistically significant differences were found in time distribution according to the mechanism of injury and cause of death (p<0.001).CONCLUSION: The distribution of overall timing of death was shown to follow a bimodal pattern rather than a trimodal model in Korea. Based on our findings, a suitable and modified trauma system must be developed.

Hoffa Fracture of Medial Femoral Condyle in a 9-Year-Old Child: A Case Report

Hoffa fractures are intra-articular fractures of the distal femoral condyles in coronal plane. These fractures may be of either condylebut lateral condyle is most commonly affected and medial condyle is extremely rare. Non-operative treatment of unicondylarfemur fractures, including Hoffa fractures, yields poor result. We present a case of 9-year-old child with Hoffa fracture of medialfemoral condyle with understanding of the mechanism of injury and its further management. He had history of fall from height ofabout 5 feet on his right knee which was in flexed position at around 90°. X-ray of knee showed fracture of medial femoral condylein coronal plane. Three-dimensional (3D) reconstruction of computed tomography (CT) scan confirmed the coronal fracture ofmedial femoral condyle and was classified as Type 33 B3 according to orthopedic trauma association classification and Type 1as per Letenneur classification. Open reduction and internal fixation were performed with partially threaded cancellous screws.The fixation of coronal fracture of medial femoral condyle done through cancellous screws in anterior to posterior direction wasadequate in giving stable fixation and aided in union without disturbing the physis of the child. At 1 year, the child could do fullextension and 130° flexion. There was no posterior or varus, valgus instability of the knee. We believe that a medial condyleHoffa fracture is extremely rare in children, and the diagnosis can be missed. ORIF using partially threaded cancellous screwsin the epiphysis provides stable fixation and can lead to a good functional outcome in the long term. The mechanism of injuryin this fracture pattern was found to be direct impact on the knee in flexed position of 90°.

Comparison of Clinical Findings and Results of Treatment According to Classification of C-2 Fractures

There are some debates on the best method of treatment of C-2 fractures. Clinical findings and results of treatment were evaluated in forty-three patients with C-2 fractures. These fractures were classified into five types according to the classification by Benzel4);1) odontoid fractures(14), 2) horizontal C-2 body fractures(13), 3) sagittally oriented vertical C-2 body fractures (2), 4) coronally oriented vertical C-2 body fractures(8), 5) traumatic spondylolisthesis of the axis(6). Primary fusion appears to be justified in odontoid process fractures due to a high rate of non-union. In horizontal C-2 body fractures, unilateral facet dislocation was visible in six patients which was the cause of malalignment in closed reduction. In sagittally oriented vertical C-2 body fractures, combined facet fractures were always visible because the mechanism of injury was axial compression. The choice of management schemes may depend on the mechanism of injury and fracture type defined by Benzel.

A Clinical Study of the Mechanism of Injury of Juvenile Tillaux Fracture and Triplane Fracture / 대한정형외과학회잡지

The juvenile Tillaux fracture and the triplane fracture of the distal end of the tibia in adolescents are considered uncommon injuries and the mechanism of both injuries has been uncertain. It has been postulated that both fractures probably are caused by external rotation of the foot. We atempted to evaluate the mechanism of injury as well as to conform the role of the external rotation of the foot for the juvenile Tillaux fracture and triplane fracture. From 1983 to 1988 at the department of orthopedic surgery, college of medicine, Hallym University, we evaluated the cases of nine adolescent patients with the juvenile Tillaux fracture and nine patients with the triplane fracture of the distal tibial epiphysis. We confirmed that external rotation force produced the triplane fracture as well as juvenile Tillaux fracture. And we could postulate that the triplane fracture needed further external rotation force, less closure of the distal tibial epiphysis, and more complicated mechanism of injury than the juvenile Tillaux fracture. The knowledge of these mechanism of injury enables us to use a rational manipulative approach to reduce these fractures.

Dislocation of the Metacarpophalangeal Joint Hand: Report of Three Cases / 대한정형외과학회잡지

Dislocation of the metacarpophalangeal joint of the finger is rare except thumb. We experienced a case of volar dislocation of little finger and 2 cases of dorsal dislocation of index finger. The mechanism of injury seems to be direct trauma to the dorsum of hand with the metacarpophalangeal joint acutely flexed in volar dislocation and the dorsal dislocation is forced the metacarpophalangeal joint into hyperextension. In 1957, Kaplan advocated the triple incision, that is release of the volar fibrocartilageous plate, the natatory ligament, and the superficial transverse metacarpal ligament, exposing the operation field through a palmar approach. The recommended treatment for such very rare injury is open reduction through nalmar approach in dorsal dislocation, and dorsal approach in volar dislocation; the single most important element preventing reduction is interposition of the volar plate within the joint space in dorsal dislocation and the obstacles of volar dislocation are entraped dorsal capsule and partial ruptured extensor tendon. In dorsal dislocation, we advocated only half release of volar fibrocartilage for lessor trauma of soft tissue and reduction was made easily after release of 1/2 volar fibrocartilage. We report this rare and interesting cases with review of literature.