A 30-year-old male was involved in a car accident. Radiographs revealed a depressed marginal fracture of the medial tibial plateau and an avulsion fracture of the fibular head. Magnetic resonance imaging showed avulsion fracture of Gerdy's tubercle, injury to the posterior cruciate ligament (PCL), posterior horn of the medial meniscus, and the attachments of the lateral collateral ligament and the biceps femoris tendon. The depressed fracture of the medial tibial plateau was elevated and stabilized using a cannulated screw and washer. The injured lateral and posterolateral corner (PLC) structures were repaired and augmented by PLC reconstruction. However, the avulsion fracture of Gerdy's tubercle was not fixed because it was minimally displaced and the torn PCL was also not repaired or reconstructed. We present a unique case of pure varus injury to the knee joint. This case contributes to our understanding of the mechanism of knee injury and provides insight regarding appropriate treatment plans for this type of injury.
Adult ; Fibula/*injuries/surgery ; Humans ; *Knee Injuries/complications/surgery ; Male ; *Multiple Trauma/complications/surgery ; *Tibial Fractures/complications/surgery

Fracture Fixation ; methods ; Humans ; Mandibular Condyle ; injuries ; Mandibular Fractures ; complications ; therapy ; Maxillary Fractures ; complications ; therapy ; Multiple Trauma ; complications ; mortality

Persistent vegetative state (PVS) is described as one of the complications of brain damage in the current forensic science literatures. PVS unrelated to brain damage, however, is not uncommon in daily forensic practice. Currently, only "Assessment for Body Impairment of the Injured in Road Traffic Accident" designates PVS as one of its items under the section of "Brain, Spinal Cord, and Nerves Injury." Therefore, it is difficult to assess the damage and disability in PVS, especially PVS due to non-brain damage. Based on a case of PVS caused by chest injury in combination with relevant literature review, this paper provides a summary on the general information, etiology, pathogenesis, clinical manifestation, diagnosis and differential diagnosis of PVS, as well as a guideline for its forensic assessment.
Adolescent ; Back Injuries/complications* ; Forensic Medicine ; Humans ; Male ; Multiple Trauma/complications* ; Persistent Vegetative State/etiology* ; Thoracic Injuries/complications*

BACKGROUND: Traumatic diaphragmatic rupture is not common, but it requires swiftly performing an emergency operation. This study was conducted to evaluate the prognostic factors for mortality after surgically treating traumatic diaphragmatic rupture. MATERIAL AND METHOD: From Jan 2001 to Dec. 2008, we experienced 37 cases of multiple traumas with diaphragmatic injuries that were confirmed by surgical procedures. We evaluated various factors, including the type of injury, the associated injuries, the preoperative vital signs, the ISS, the time until surgery and the rupture size. RESULT: There were 30 patients with blunt trauma and 7 patients with penetrating trauma. Thirty-four patients had associated injuries and the mean ISS was 20.8. Postoperative complications occurred in 11 patients and hospital mortalities occurred in 6 patients. The prognostic factors that had an influence on the postoperative mortalities were the preoperative intubation state, the patient who exhibited hypotension and a high ISS. CONCLUSION: Traumatic diaphragmatic rupture is just one part of multiple traumas. The postoperative mortalities might depend on not only on the diaphragmatic rupture itself, but also on the severity of the associated injuries.
Diaphragm ; Emergencies ; Hospital Mortality ; Humans ; Hypotension ; Intubation ; Multiple Trauma ; Postoperative Complications ; Prognosis ; Rupture ; Vital Signs

Spondyloptosis in the clinic is rarely reported. We herein present a 47-year-old female, who suffered from a crush injury directly by a heavy cylindrical object from the lateral side. She was diagnosed to have traumatic L₃ spondyloptosis with multiple traumas. Staged surgical procedures were conducted and a three-year follow-up was obtained. Eventually, normal spinal alignment was restored, and neurological deficits were gradually improved. At three years follow-up, the motor strength scores and function of the sphincters were incompletely improved. Previously published reports on traumatic lumbar spondyloptosis were reviewed and several critical points for management of this severe type of spinal injury were proposed. First, thoracolumbar and lumbosacral junction were mostly predilection sites. Second, numerous patients involving traumatic lumbar spondyloptosis were achieved to American Spinal Injury Association grade A. Third, lumbar spondyloptosis was commonly coupling with cauda equina injury. Finally, the outcomes were still with poorly prognosis and recovery of patients was correlation to spondyloptosis severity. Based on this case report and literatures review, we highlighted that the spinal alignment restoration relying on staged operations and following rehabilitation hereof are both important once facing with multiple traumas. Furthermore, we suggested to perform routine CT angiography during lumbar spondyloptosis to justify whether there are large vessel compression or injury.
Female ; Humans ; Middle Aged ; Lumbar Vertebrae/injuries* ; Spondylolisthesis/surgery* ; Spinal Injuries ; Multiple Trauma/complications*

OBJECTIVETo investigate the surgical treatment for patients with multiple injuries in ICU.

METHODSClinical data of 163 multiple injury patients admitted to ICU of our hospital from January 2006 to January 2009 were retrospectively studied, including 118 males and 45 females, with the mean age of 36.2 years (range, 5-67 years). The injury regions included head and neck (29 cases), face (32 cases), chest (89 cases), abdomen (77 cases), pelvis and limbs (91 cases) and body surface (83 cases). There were 57 cases combined with shock. ISS values varied from 10 to 54, 18.42 on average. Patients received surgical treatments in ICU within respectively 24 hours (10 cases), 24-48 hours (8 cases), 3-7 days (7 cases) and 8-14 days (23 cases).

RESULTSFor the 163 patients, the duration of ICU stay ranged from 2 to 29 days, with the average value of 7.56 days. Among them, 143 were cured (87.73%), 11 died in the hospital (6.75%) due to severe hemorrhagic shock (6 cases), craniocerebral injury (3 cases) and multiple organ failure (2 cases), and 9 died after voluntarily discharging from hospital (5.52%). The total mortality rate was 12.27%.

CONCLUSIONSThe damage control principle should be followed when multiple injury patients are resuscitated in ICU. Surgical treatment strategies include actively controlling hemorrhage, treating the previously missed injuries and related wounds or surgical complications and performing planned staging operations.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Multiple Trauma ; surgery ; Postoperative Complications ; surgery

Adult ; Aged ; Female ; Humans ; Lower Extremity ; injuries ; Male ; Middle Aged ; Multiple Trauma ; complications ; nursing ; surgery ; Orthopedic Procedures ; Shock ; nursing

OBJECTIVETo explore the treatment of casualties who suffered from multiple injuries in earthquake and had been treated by damage control (DC) immediately,and the definite postponed surgery time by way of APACHE II score.

METHODSFrom May to June 2008, 21 casualties who had undergone DC accepted further treatment of medicine and surgery, and recovered physical potentiality in the intensive care unit (ICU). APACHE II score was adopted to evaluate the casualties' physical potentiality. Then, internal fixation of intra-articular fractures and centrum fractures, alternation from external fixation to internal fixation, reconstruction of soft tissue was applied by stages according to the plan.

RESULTSAll the patients were effectively cured after definite postponed surgery. There was less complication, low deformity ratio and no death happened.

CONCLUSIONTimely evaluation of the casualties' physical potentiality, appropriate surgery time and exact surgery can reduce the casualties' complication, deformity rate and death rate.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; Earthquakes ; Female ; Fracture Fixation ; Fractures, Bone ; complications ; surgery ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Multiple Trauma ; complications ; surgery ; Treatment Outcome

OBJECTIVETo investigate the therapeautic effect of damage control orthopaedics (DCO) applicated to thoracolumbar burst fracture complicated with severe polytrauma.

METHODSTwenty-one patients with severe polytrama including 15 males and 6 females with an average age of 40-years-old ranging from 20 to 60 years, were treated by immediate fluid resuscitation and emergency simple operation so as to control the bleeding and contamination. According to Frankel grade of spinal nerves function, 3 cases were grade A, 3 were grade B, 9 were grade C, 6 were grade D. Ten cases were performed to open abdominal operation, 6 cases underwent closed negative pressure drainage thorough chest, 2 cases with lung rupture were treated by repairing operation. During operation, 9 cases were treated with by external fixation and 5 cases were skeletal traction or external fixation with plaster support for extremities fractures. After emergency operation, the patients were transported into surgical intensive care unit (SICU), and corrected the hypothermia, acidosis and coagulation. The definitive thoracolumbar operation was performed between 5 to 7 days as soon as the vital signs became stable.

RESULTSAmong 21 cases, trauma hemorrhagic shock was corrected rapidly in 18 cases and 3 cases died in 4 to 26 hours. The survival rate was about 85.7% (18/21). Eighteen patients were followed up for 6 to 14 months with an average of 10 months. According to Frankel grading, 3 cases were grade A, 2 cases were grade B, 3 cases were grade C, 3 cases were grade D, 7 cases were grade E.

CONCLUSIONIt may increase the therapy achievement rate excellently and decrease the disabled rate that performing damage control orthopaedics (DCO) timely, relifing the compression on the spinal cord and re-establishing the stability of spinal column as early as possible.

Adult ; Humans ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Multiple Trauma ; etiology ; surgery ; Orthopedic Procedures ; Spinal Fractures ; complications ; surgery ; Thoracic Vertebrae ; injuries ; surgery ; Young Adult

OBJECTIVETo investigate the efficiency of damage control surgery (DCS) and predictors of mortality in critically multiple trauma patients.

METHODSFrom May 1998 to February 2007, DCS were carried out in 27 patients with critically multiple trauma. Of the patients 15 cases survived (survival group) and 12 cases died (dead group). The surgical complications, causes of death, demographic, physiologic and medical parameters were collected and compared between the two groups. Multiple logistic regression analysis were performed to identify possible predictors of mortality.

RESULTSThe incidence of surgical complications was 37.0 percent, and the intra-abdominal infections was the most frequent (18.5%). The overall mortality rate was 44.4 percent. The most common causes of death was multiple organ dysfunction syndrome (50.0%). With respect to predicting mortality, statistically significant differences was found in parameters as age, injury severity score (ISS), initial temperature and base excess (BE), estimated blood loss, initial ICU temperature and length of hospital stay. Older age, increased absolute value of initial BE and lower initial ICU temperature were determined as independent predictors of mortality on multiple logistic regression analysis.

CONCLUSIONSThere is a comparable high morbidity and mortality rate in severely injured patients managed with DCS. Increased age, a larger absolute value of initial BE and lower initial ICU temperature could independently predict death of the patients.

Adolescent ; Adult ; Age Factors ; Aged ; Female ; Humans ; Injury Severity Score ; Logistic Models ; Male ; Middle Aged ; Multiple Trauma ; mortality ; surgery ; Multivariate Analysis ; Postoperative Complications ; Prognosis ; Temperature ; Young Adult