The present report is a retrospective review comparing how a change in treatment protocol affected 24-hour outcomes for patients with pelvic ring and/or acetabular fractures with multiple trauma who were admitted to our hospital during two separate time periods. Prior to January 2009, patients with pelvic ring injuries and hemodynamic instability underwent early angiography. From January 2009, the protocol was revised, with patients now undergoing early pelvic packing and external fixation. Our objective in the present study was to evaluate and compare the mortality and outcomes of patients with pelvic or acetabular fractures who underwent early pelvic angiography to those who underwent early retroperitoneal pelvic packing. A total of 118 patients admitted to our hospital between December 2001 and January 2006 with pelvic or acetabular fractures and an Injury Severity Score (ISS) greater than 16 were included in the study. Twenty-one patients died (17%) within 24 hours of being admitted. The independent risk factors for death were ISS, Revised Trauma Score (RTS), preferred TAE protocol, and pelvic packing. Results from this study suggest that the change in protocol has had an impact on patients' prognoses.
Objective : We evaluated the cases that underwent transcatheter arterial embolization (TAE) for pelvic fracture at our department. Methods : Using medical records from January 2010 to December 2013, we examined 24 cases that were treated by urgent TAE for pelvic fracture and analyzed the significance of differences between the survival group and the non-survival group statistically. Results : The non-survival group was significantly accompanied by acidosis, coagulopathy, unstable hemodynamics, and prolonged hemorrhagic shock. There were significantly more cases with retroperitoneal bleeding at other sites in the non-survival group. Nonselective embolization was performed in 50%, but there were no local complications. As for the location of extravasation, internal iliac artery constituted 88%, but the rate of multiple extravasation at more than 2 vessels was 75%. There was no correlation between pelvic fracture type and the location of extravasation. Conclusions : It is important that we initially perform evaluation of the general condition and imaging diagnosis, after which we must perform effective TAE in a short time without underestimating the bleeding at other sites.
An 83-year-old man was brought to our hospital after a traffic accident. He exhibited respiratory failure, which was caused by an upper airway obstruction that occurred due to bilateral vocal cord paralysis. It was an emergency state and he underwent oral tracheal intubation. CT scan showed a thyroid cartilage fracture. Subsequently, he underwent tracheotomy and was transferred to another hospital to undergo conservative treatment. Laryngeal trauma is relatively uncommon, and treatment of the acute phase consists of airway management. We need to recognize laryngeal trauma based on the mechanism of injury or symptoms and perform reliable intubation or surgical airway management during airway emergency. Because tracheal intubation after laryngeal trauma may cause airway obstruction, we should prepare for emergency airway management.
A 56-year-old male was brought to our emergency department because of self-inflicted stab wounds, six hours after injury. His consciousness was clear and vital signs were stable on admission. There were multiple stab wounds reaching the thorax and abdominal cavity. Emergency thoracostomy, laparotomy, and hemostasis were performed. On hospital day 4, after extubation, neurological examination revealed mild disturbance of his speech and difficulty moving the fingers of his right hand. Head MRI revealed a high-intensity signal lesion at the bilateral basal ganglia on DWI, FLAIR, and T2-weighted images. An ADC map showed decreased intensity at the corresponding area. SPECT (99mTc-ECD) revealed mean cerebral blood flow (mCBF) of 44ml/100 g/min and decreased regional CBF in the left basal ganglia. On follow-up MRI and CT, the ischemic lesion remained. This case was diagnosed as hypoxic ischemic encephalopathy due to the loss of blood because of multiple wounds without obvious hemorrhagic shock.
A man in his 70s underwent emergency hospitalization 6 hours after his chest had been compressed by a tractor. Respiratory rate was elevated and moist rales were heard in both lungs. Neither flail chest nor subcutaneous emphysema was observed. PO2 decreased to 62.6 mmHg under high-concentration oxygen administration. Fractures of the left third through tenth and right third through eleventh ribs were present, and bilateral pulmonary contusions and hemothorax were diagnosed. Analgesics were administered for pain control. PO2 remained unimproved 10 hours after admission. Non-invasive positive-pressure ventilation (NPPV) was applied, after which respiratory status improvement and satisfactory pain control were achieved. Oral intake in the form of a high-density liquid diet was initiated 48 hours after commencing NPPV. NPPV was discontinued 84 hours after commencement, and the patient was then transferred to another hospital on the 9th hospital day. The present case suggests that NPPV can be effective in better ventilation and treatment of lung edema in conscious patients with blunt chest trauma under good pain control.
We treated a case of traumatic extraperitoneal bladder rupture and achieved a good clinical outcome via surgical operation. The patient, a 70-year-old female, had jumped from the 2nd floor of a building in order to commit suicide. Contrast computed tomography images showed disruption of the bladder wall, and extravasation of contrast medium was observed. After tests, the vital signs showed that the patient had gone into shock, and emergency surgery was performed. We repaired an 8-cm-long injury of the anterior bladder wall. The postoperative course was favorable. A contrasted cystogram was obtained 3 weeks postoperatively. We confirmed that there was no leakage of contrast medium from the bladder wall. The patient had extraperitoneal bladder rupture complicating a pelvic fracture, and a pessary may have caused enlargement of the injury site. We selected surgical operation for this case of extraperitoneal bladder rupture and achieved a favorable clinical outcome.