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*

PURPOSE: To summarize and analyze the early treatment of multiple injuries combined with severe pelvic fractures, especially focus on the hemostasis methods for severe pelvic fractures, so as to improve the successful rate of rescue for the fatal hemorrhagic shock caused by pelvic fractures. METHODS: A retrospective analysis was conducted in 68 cases of multiple trauma combined with severe pelvic fractures in recent 10 years (from Jan. 2006 to Dec. 2015). There were 57 males and 11 females. Their age ranged from 19 to 75 years, averaging 42 years. Causes of injury included traffic accidents in 34 cases (2 cases of truck rolling), high falling injuries in 17 cases, crashing injuries in 15 cases, steel cable wound in 1 case, and seat belt traction injury in 1 case. There were 31 cases of head injury, 11 cases of chest injury, 56 cases of abdominal and pelvic injuries, and 37 cases of spinal and limb injuries. Therapeutic methods included early anti-shock measures, surgical hemostasis based on internal iliac artery devasculization for pelvic hemorrhage, and early treatment for combined organ damage and complications included embolization and repair of the liver, spleen and kidney, splenectomy, nephrectomy, intestinal resection, colostomy, bladder ostomy, and urethral repair, etc. Patients in this series received blood transfusion volume of 1200-10,000 mL, with an average volume of 2850 mL. Postoperative follow-up ranged from 6 months to 1.5 years. RESULTS: The average score of ISS in this series was 38.6 points. 49 cases were successfully treated and the total survival rate was 72.1%. Totally 19 patients died (average ISS score 42.4), including 6 cases of hemorrhagic shock, 8 cases of brain injury, 1 case of cardiac injury, 2 cases of pulmonary infection, 1 case of pulmonary embolism, and 1 case of multiple organ failure. Postoperative complications included 1 case of urethral stricture (after secondary repair), 1 case of sexual dysfunction (combined with urethral rupture), 1 case of lower limb amputation (femoral artery thrombosis), and 18 cases of consumptive coagulopathy. CONCLUSION The early treatment of multiple injuries combined with severe pelvic fractures should focus on pelvic hemostasis. Massive bleeding-induced hemorrhagic shock is one of the main causes of poor prognosis. The technique of internal iliac artery devasculization including ligation and embolization can be used as an effective measure to stop or reduce bleeding. Consumptive coagulopathy is difficult to deal with, which should be detected and treated as soon as possible after surgical measures have been performed. The effect of using recombinant factor VII in treating consumptive coagulopathy is satisfactory.
Adult ; Embolization, Therapeutic ; methods ; Factor VII ; administration & dosage ; Female ; Fractures, Bone ; complications ; therapy ; Hemostasis, Surgical ; Humans ; Iliac Artery ; surgery ; Injury Severity Score ; Ligation ; Male ; Middle Aged ; Multiple Trauma ; complications ; therapy ; Pelvic Bones ; injuries ; Prognosis ; Recombinant Proteins ; administration & dosage ; Retrospective Studies ; Shock, Hemorrhagic ; etiology ; prevention & control ; Young Adult

OBJECTIVETo discuss the application and clinical effect of damage control concept in the treatment of severe limbs fractures combining with multiple trauma.

METHODSFrom July 2009 to July 2012, 30 patients with severe limbs fractures combining with multiple trauma were treated with the damage control concept, included 20 males and 10 females with an average age of (34.03 ± 12.81) years old ranging from 20 to 60 years old; the ISS averaged (35.00 ± 12.81) points (ranged from 26 to 54 points). And the control group also contained 30 patients with severe limbs fractures combining with multiple trauma treated by the traditional operation from June 2006 to June 2009, there were 23 males and 7 females with an average age of (34.23 ± 11.04) years old ranging from 18 to 65 years old. The ISS averaged (35.56 ± 11.04) points (ranged from 26 to 51 points). The age, gender, ISS, Gustilo classification, operation time, intraoperative blood loss, blood transfusion,postoperative complications and mortality rate were observed and compared.

RESULTSIn the damage control concept group,there were 28 cases surviving and 2 cases (6.7%) death; 6 cases of postoperative complication included 2 cases of adult respiratory distress syndrome, 1 case of multiple organ failure, 1 case of disseminated intravascular coagulation and 2 cases of wound infection. In the control group, there were 22 cases surviving and 8 cases death(26.7%); 13 cases of postoperative complication included 4 cases of adult respiratory distress syndrome,2 cases of multiple organ failure, 2 cases of disseminated intravascular coagulation and 3 cases of wound infection. There were no statistically significant differences between two groups in age, gender, ISS, Gustilo classfication and complication (P > 0.05), however there were statistically significant differences in mortality rate, operation time, blodd loss, blodd transfusion between two groups (P < 0.05).

CONCLUSIONDamage control concept is used to treat severe limbs fractures combining with multiple trauma which has the rapid and effective therapy, can improve survival rate and reduce complication.

Adolescent ; Adult ; Aged ; Embolism, Fat ; prevention & control ; Extremities ; injuries ; Female ; Humans ; Male ; Middle Aged ; Multiple Trauma ; surgery ; Postoperative Complications ; prevention & control

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

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

OBJECTIVE: To determine the characteristics, classification, and treatment of thoracic fracture accompanied with sternum fracture. METHODS: Data of 32 patients with thoracic fractures accompanied with sternum fracture were reviewed. Patients information such as age, gender, cause of injury, site of sternum fracture, level and type of thoracic vertebral fracture, spinal cord injury and associated injuries was included in the analysis. Of the 32 patients, 13 had compressed fractures, 13 had fracture-dislocations, 5 had burst fracture and 1 had burst-dislocation. Six patients had a complete lesion of the spinal cord, 13 sustained a neurologically incomplete injury, and the other 13 were neurologically intact. Ten patients were treated nonoperatively and the other 22 surgically. RESULTS: All patients were followed up for 10-103 months. Road traffic accidents and falling dominated among the causes. All patients were accompanied with other injuries. None of the 6 patients with a complete paralitic lesion regained any significant function. Of the 13 neurologically intact patients, 5 had local pain although 12 of them remained normal function. One patient showed tardive paralysis. Three of the 13 patients with incomplete paraplegia returned to normal, 5 regained some function and 5 did not recover. CONCLUSION Thoracic fractures accompanied with sternum fracture are marked by violent force, severe fracture of the spine, severe injuries of the spinal cord, and high incidence of other injuries. The new classification method is more suitable to thoracic fractures accompanied with sternum fracture,and confirms the existence and clinical relevance of the 4th column of the thoracic spine and its role in providing spinal stability in patients with thoracic fracture.
Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; methods ; Fractures, Bone ; classification ; complications ; surgery ; Fractures, Compression ; surgery ; Humans ; Joint Dislocations ; surgery ; Male ; Middle Aged ; Multiple Trauma ; classification ; Spinal Fractures ; classification ; complications ; surgery ; Sternum ; injuries ; 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

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 relationship between the operation time of femur shaft fracture with post-operation system inflammation changes and clinical outcomes for those multiple fractures.

METHODSThis investigation was designed as a prospective, nonrandomized cohort study. From April 2005 to August 2007, all 78 hospitalized patients were divided into 3 groups by an inclusion criteria: multiple fractures with opened fracture of femur shaft (group A, n = 26), multiple fractures with closed fracture of femur shaft (group B, n = 23), single closed fracture of femur shaft (group C, n = 29). In the group A, damage control orthopaedics (DCO) procedure were performed. In the group B and C, all the femur shaft fractures were performed intramedullary nail fixation early (< 24 h). From serially sampled venous blood, inflammatory reaction index were estimated by measured the concentration of IL-6, TNF-alpha surround the operation, and the conditions of multiple organs were estimated by assayed PaO2/FiO2, total bilirubin (TBIL), creatinine (Cr) levels, the postoperation complication rates were analyzed among each groups. The extent of inflammation changes, multiple organs damage conditions and postoperation complication rates were compared and analyzed among the 3 groups.

RESULTSIn the group A, the median increase values of IL-6,TNF-alpha after the secondary surgery were 59 ng/L and 85 ng/L, whereas they were 154 ng/L and 250 ng/L respectively in the group B, there was a significant difference between the 2 groups (P < 0.01). In addition, the median increase values of IL-6, TNF-alpha after the first surgery in group A and in group C were both significantly less than group B (P < 0.01). Correspondingly, the abnormal rates of PaO2/ FiO2, TBIL, Cr levels occurred in the group B were all greater than group A after the 2 surgery procedures (P < 0.05), and in the aspects of average ventilation days, ICU staying days, duration of positive fluid balance (input/output > 500 ml/24 h), the group B were all greater than group A after the second surgery ( P < 0.01). Compared with group A after the first surgery, group B showed a longer average ventilation days, but it had no significant difference in average ICU stay days and duration of positive fluid balance. In addition, for group C, all the aspects above were less than group B (P < 0.01). Concerned with the complications after surgery in each groups, fat embolism and MODS rate between group A and B had no significant difference (11.5% vs 13.0% ,P > 0.05), but higher than which of group C (P < 0.01).

CONCLUSIONSThe early intramedullary nail fixation of femur shaft fracture in multiple fractures may lead to a significant system inflammation changes, and may develop the subclinical changes of multiple organs. However, these changes are less in those surgery procedures later performed, namely intramedullary nail fixation of femur shaft fracture in multiple fractures as a primary definitive treatment has a potential risk, and should be carefully evaluated.

Adolescent ; Adult ; Female ; Femoral Fractures ; blood ; surgery ; Fracture Fixation, Intramedullary ; adverse effects ; Humans ; Interleukin-6 ; blood ; Male ; Middle Aged ; Multiple Trauma ; blood ; surgery ; Postoperative Complications ; prevention & control ; Prospective Studies ; Time Factors ; Treatment Outcome ; Tumor Necrosis Factor-alpha ; metabolism