MyMedR

Fulltext Thoracic Endovascular Aortic Repair (TEVAR) in traumatic high-velocity blunt injury to thoracic aorta

Nor Elina NS, Naresh G, Hanif H, Zainal AA

Med J Malaysia, 2013 Jun;68(3):239-44.

PMID: 23749014 MyJurnal

Matched MeSH terms: Wounds, Nonpenetrating/surgery

Fulltext Computed tomography (CT) in blunt liver injury: a pictorial essay

Radhiana H, Azian AA, Razali MR, Kamariah CM

Med J Malaysia, 2010 Dec;65(4):319-25.

PMID: 21901958

Computed tomography (CT) is widely used in assessing clinically stable patients with blunt abdominal trauma. In these patients, liver is one of the commonest organs being injured and CT can accurately identify and assess the extent of the injury. The CT features of blunt liver trauma include laceration, subcapsular or parenchymal haematomas, active haemorrhage and vascular injuries. Widespread use of CT has notably influenced the management of blunt liver injury from routine surgical to nonsurgical management. We present pictorial illustrations of various liver injuries depicted on CT in patients with blunt trauma.

Matched MeSH terms: Wounds, Nonpenetrating/radiography*

Fulltext Pitfall in diagnostic trauma laparoscopy

Yeap BH, Premnath N, Manjit S

Med J Malaysia, 2005 Mar;60(1):89-90.

PMID: 16250287

The resurging interest in diagnostic laparoscopy has witnessed its increasing application in trauma surgery. Such unbridled enthusiasm has at times overlooked its shortcoming in the diagnosis and management of certain in abdominal injuries. We report and discuss one such conspicuous limitation and advocate that the use laparoscopy in abdominal trauma should be tempered with caution.

Matched MeSH terms: Wounds, Nonpenetrating/diagnosis*

Fulltext Traumatic dislocation of the knee

Dhillon KS, Teng TK

Med J Malaysia, 1987 Sep;42(3):173-6.

PMID: 3506639

This study analyses retrospectively the results of sixteen acute dislocations of the knee at the University Hospital, Kuala Lumpur from 1980 to 1985. The average follow-up was 3.5 years. There were seven posterior, six anterior, one lateral and two postero-lateral dislocations. All were due to motor vehicle accidents except one. There were four patients with popliteal artery injury and two patients with peroneal nerve injury; three required amputations due to late detection. All the peroneal nerve palsies were permanent. The results of surgical treatment appear to be better than conservative management of acute dislocation of the knee.

Matched MeSH terms: Wounds, Nonpenetrating/therapy

Isolated hyoid bone fracture in a child due to a fall

Chainchel Singh MK, Siew SF, Lai PS

Int J Pediatr Otorhinolaryngol, 2020 Dec;139:110443.

PMID: 33068949 DOI: 10.1016/j.ijporl.2020.110443

Hyoid bone fractures due to blunt trauma are rare accounting for only 0.002% of all head and neck fractures with most documented fractures being due to strangulation, hanging, motorcycle helmet straps, sports injuries and rarely as a complication of intubation. However, they are even rarer in the paediatric age group. We present a hyoid bone fracture in a two-year-old child as a result of a fall down three steps. Hyoid bone fractures though generally heal well with conservative treatment must be diagnosed early to avoid air way obstruction leading to morbidity and mortality.

Matched MeSH terms: Wounds, Nonpenetrating*

Fulltext Discriminant ability of the shock index, modified shock index, and reverse shock index multiplied by the Glasgow coma scale on mortality in adult trauma patients: a PATOS retrospective cohort study

Chen TH, Wu MY, Do Shin S, Jamaluddin SF, Son DN, Hong KJ, et al.

Int J Surg, 2023 May 01;109(5):1231-1238.

PMID: 37222717 DOI: 10.1097/JS9.0000000000000287

BACKGROUND: The shock index (SI) predicts short-term mortality in trauma patients. Other shock indices have been developed to improve discriminant accuracy. The authors examined the discriminant ability of the SI, modified SI (MSI), and reverse SI multiplied by the Glasgow Coma Scale (rSIG) on short-term mortality and functional outcomes.

METHODS: The authors evaluated a cohort of adult trauma patients transported to emergency departments. The first vital signs were used to calculate the SI, MSI, and rSIG. The areas under the receiver operating characteristic curves and test results were used to compare the discriminant performance of the indices on short-term mortality and poor functional outcomes. A subgroup analysis of geriatric patients with traumatic brain injury, penetrating injury, and nonpenetrating injury was performed.

RESULTS: A total of 105 641 patients (49±20 years, 62% male) met the inclusion criteria. The rSIG had the highest areas under the receiver operating characteristic curve for short-term mortality (0.800, CI: 0.791-0.809) and poor functional outcome (0.596, CI: 0.590-0.602). The cutoff for rSIG was 18 for short-term mortality and poor functional outcomes with sensitivities of 0.668 and 0.371 and specificities of 0.805 and 0.813, respectively. The positive predictive values were 9.57% and 22.31%, and the negative predictive values were 98.74% and 89.97%. rSIG also had better discriminant ability in geriatrics, traumatic brain injury, and nonpenetrating injury.

CONCLUSION: The rSIG with a cutoff of 18 was accurate for short-term mortality in Asian adult trauma patients. Moreover, rSIG discriminates poor functional outcomes better than the commonly used SI and MSI.

Matched MeSH terms: Wounds, Nonpenetrating*

Fulltext Appendicitis following blunt abdominal trauma

Ramesh G, Ho PW, Ng KL, Jegan T

Med J Malaysia, 2002 Mar;57(1):123-4.

PMID: 14569731

A young boy presented with history of abdominal trauma. History and initial clinical findings suggested a soft tissue injury. Due to increasing abdominal pain and fever, we proceeded with an exploratory laparotomy with a diagnosis of intra-abdominal injury, at which we found a perforated appendix. Appendicitis following blunt abdominal trauma needs high index of suspicion.

Matched MeSH terms: Wounds, Nonpenetrating/complications*; Wounds, Nonpenetrating/diagnosis; Wounds, Nonpenetrating/surgery

Blunt abdominal trauma--injury assessment in relation to early surgery

Visvanathan R, Low HC

J R Coll Surg Edinb, 1993 Feb;38(1):19-22.

PMID: 8437147

One hundred and thirteen patients sustaining blunt abdominal trauma over a 24-month period were retrospectively divided into three groups to assess parameters of three diagnostic methods and the time-lapse before implementing surgical treatment. Diagnosis was based in group A patients (n = 20) on physical findings, plain radiology, and blood and urine examinations. Diagnostic methods in group B patients (n = 35) and in group C patients (n = 58) were as in group A but with the addition of diagnostic peritoneal lavage (DPL) in group B or with the addition of diagnostic abdominal ultrasonography (DAU) in group C. Sixty-five patients underwent abdominal exploration. The time-lag from commencement of examination to surgery was 332.33 +/- 48.90 min, 251.82 +/- 29.08 min and 570.89 +/- 133.80 min respectively in groups A, B and C. It was significantly shorter in group B compared with group C (P = 0.03). DPL had a sensitivity of 95%, a specificity of 81% and an accuracy of 89% whilst DAU had a sensitivity of 79%, a specificity of 85% and an accuracy of 83% in detecting significant injury. The conclusion is that DPL in combination with DAU would facilitate early assessment and treatment of intra-abdominal injuries.

Matched MeSH terms: Wounds, Nonpenetrating/diagnosis*; Wounds, Nonpenetrating/surgery; Wounds, Nonpenetrating/ultrasonography

Fulltext Renal trauma: a local experience

Mack POP, Ng HN

Med J Malaysia, 1985 Dec;40(4):312-6.

PMID: 3842731

40 cases of major renal trauma over a period of five years in a peripheral hospital in Singapore were reviewed. 90% were due to blunt trauma with motor-cycle accidents forming the majority. There were five cases of superficial cortical injury, three cases of shattered kidneys, six cases of parenchymal injuries, one case of pedicle injury and one case of combined pedicle and parenchymal injury. Nephrectomy rate was 22.5% in this series. This is felt to be unduly high. Half of all the cases operated upon ended up with an immediate total nephrectomy. There was no mortality in this series. We recommend a more conservative policy of watchful waiting to achieve better chances of organ preservation without increasing mortality.

Matched MeSH terms: Wounds, Nonpenetrating/complications; Wounds, Nonpenetrating/radiography; Wounds, Nonpenetrating/surgery*

Fulltext Emergency thoracotomy and major lung resection for penetrating chest trauma: Lessons learnt from a review of three cases

Sachithanandan A, Fahmi PA, Faisal I, Badmanaban B, Abdul Muis J, Mohd Arif MN

Med J Malaysia, 2013 Jun;68(3):227-30.

PMID: 23749011 MyJurnal

Emergency lung resection for chest trauma is a rare event with a reported incidence of 0.08-1.3% but is associated with a high morbidity and mortality especially if a pneumonectomy is required, if due to blunt chest trauma or when concomitant injuries are present. We report three cases of young adult males with penetrating chest injuries that required emergency thoracotomy (ET) and anatomical lung resection to achieve definitive control of life threatening pulmonary haemorrhage. All patients survived to hospital discharge and remained well on follow-up. Indications for an ET and what constitutes the optimal operative management of such patients is discussed.

Matched MeSH terms: Wounds, Nonpenetrating/surgery

Fulltext Management of isolated splenic injuries after blunt trauma: an institution's experience over 6 years

Tan KK, Chiu MT, Vijayan A

Med J Malaysia, 2010 Dec;65(4):304-6.

PMID: 21901951

Forty-two patients with traumatic blunt splenic injuries were admitted over a six year period. Vehicular-related collisions and fall from height accounted for the injuries in 38 (90.5%) of them. Eleven (26.2%) underwent immediate surgery (7 splenectomy and 4 splenorrhaphy), while the remaining 31 patients were treated nonoperatively of which 3 underwent angio-embolisation. Twenty seven patients had either grade III or IV splenic injuries. Operative management was more likely in patients with lower haemoglobin or with more severe splenic injury. Nonoperative management can be adopted in patients with blunt isolated splenic injuries but operative management is still indispensable in certain instances.

Matched MeSH terms: Wounds, Nonpenetrating/therapy*

Fulltext Pseudophacocoele following blunt ocular trauma

Aziz S, Asokumaran T, Intan G

Med J Malaysia, 2011 Mar;66(1):64-5.

PMID: 23765148 MyJurnal

Blunt ocular trauma may result in expulsion of the intraocular lens in a patient who has undergone cataract surgery. This case report describes a patient who presented with an extrusion of intraocular lens following blunt ocular trauma post-operatively. The authors emphasise the importance of patient counselling and protection of the operated eye after surgery.

Matched MeSH terms: Wounds, Nonpenetrating/surgery

Fulltext The Macklin effect--pneumomediastinum and pneumopericardium following blunt chest trauma

Baharudin A, Sayuti RM, Shahid H

Med J Malaysia, 2006 Aug;61(3):371-3.

PMID: 17240595

Pneumomediastinum and pneumopericardium following blunt chest trauma are rare. Diagnosis is by chest radiograph and CT Scan. They have to be identified and treated accordingly. Usually, pneumomediastinum and pneumopericardium are self-limiting requiring no specific therapy. However, vigilance and a continuous monitoring of the vital signs are necessary.

Matched MeSH terms: Wounds, Nonpenetrating/complications*

Fulltext Traumatic chylothorax following a closed chest injury

Krishnan MMS, Jeyaratnam K

Med J Malaysia, 1982 Sep;37(3):270-2.

PMID: 7177011

A case of traumatic chylothorax is presented with its typical clinical presentation. Failure of conservative measures led to a transthoracic ligation of the thoracic duct, with good result.

Matched MeSH terms: Wounds, Nonpenetrating/complications*

Computed tomography of the thorax with 3D reconstruction in penetrating chest injury

Michael A, Yahya ZO, Mdrazali I, Hanif H

Med J Malaysia, 2017 02;72(1):75-76.

PMID: 28255150 MyJurnal

Penetrating chest wounds is less common but more deadly then blunt trauma. Majority of penetrating chest trauma can be managed conservatively with observation and simple thoracotomy. This case report highlights a bizarre occupational hazard causing a penetrating chest injury and the option of non-invasive management with the aid of computed tomography with 3D reconstruction.

Matched MeSH terms: Wounds, Nonpenetrating

Fulltext The role of multislice computed tomography (MSCT) in the detection of blunt traumatic intra abdominal injury: our experience in Hospital Tengku Ampuan Afzan (HTAA), Kuantan, Pahang

Radhiana H, Azian AA, Mubarak MY, Saat A, Mohd Amran AR, Jamalludin AR

Med J Malaysia, 2012 Jun;67(3):316-22.

PMID: 23082425 MyJurnal

Multislice computed tomography (MSCT) is the imaging modality of choice in assessing clinically stable patients with blunt abdominal trauma. This study assessed the role of MSCT in the detection of intra abdominal injury caused by blunt trauma in our centre within a two-year-period (2008-2009). A total of 151 patients had MSCT abdomen for blunt abdominal trauma within this study period. Positive scan were seen in 126 patients (83.4%). Out of these positive scans, liver, spleen and renal injuries were seen in 42.1% (n = 53), 34.9% (n = 44) and 30.0% (n = 34) of cases respectively. Laparotomies were performed in 45 patients. Out of these 45 laparotomies, 10 patients had surgically significant injuries that were missed on CT scan findings. The injuries were bowel perforation (n = 4), serosal tear of bowel (n = 1), mesenteric injuries with active haemorrhage (n=3), spleen injury (n = 1) and liver injury (n = 1).

Matched MeSH terms: Wounds, Nonpenetrating/radiography*; Wounds, Nonpenetrating/surgery

Simulation of motorcycle crashes with w-beam guardrail: injury patterns and analysis

Ibitoye AB, Hamouda AM, Wong SV, Umar RS

Proc Inst Mech Eng H, 2009 Nov;223(8):1033-40.

PMID: 20092099

This study uses computer simulations to study the impact of a motorcycle with the conventional w-beam guardrail. A three-dimensional computer simulation of a scaled hybrid III 50th-percentile male dummy mounted on a motorcycle and colliding with a w-beam guardrail is carried out. A multi-body model of the motorcycle and finite element model of the guardrail are developed using commercially available software. The simulation model is validated with a physical crash test conducted with same initial impact configurations. Impacts at speeds of 32, 48, and 60 km/h at an impact angle at 45 degrees are considered. The predicted forces and accelerations are compared with the biomechanical limits for each body part and the risk of injury to the rider are evaluated. Speed was found to have a significant influence on the level of injury to the head, neck, chest, and femur. A significant reduction of the severity of injuries was found when the impact speed was reduced from 60 to 32km/h. The accelerations experienced by the head and chest are found to be higher than safe levels for impact speeds of 48 and 60 km/h. The biomechanical limit for the right femur is exceeded at all three considered impact speeds. Neck injuries are also a concern, with the predicted tension values and neck bending extent being higher than the biomechanical limit for the 60 km/h impact speed. In light of these results, it is suggested that the design of guardrails should be reviewed with a focus on the safety of motorcyclists.

Matched MeSH terms: Wounds, Nonpenetrating/etiology; Wounds, Nonpenetrating/physiopathology*

Traumatic abdominal wall hernia - a case of handlebar hernia

Vincent K, Cheah SD

Med J Malaysia, 2018 12;73(6):425-426.

PMID: 30647222

Traumatic abdominal wall hernia (TAWH) after blunt injury is uncommon. Diagnosis requires careful examination and high index of suspicion. We report a case of a 12-year-old boy who complained of painful abdominal swelling over the left iliac fossa after a bicycle-handlebar hit his abdomen. TAWH was diagnosed clinically and confirmed with ultrasound and computed tomography (CT) scan. He developed incarceration after 12 hours of admission and subsequently underwent primary repair without mesh. As TAWH is usually associated with other concomitant injuries, it is important that we are meticulous to rule out other serious concomitant injuries.

Matched MeSH terms: Wounds, Nonpenetrating/complications*; Wounds, Nonpenetrating/diagnosis

Managing traumatic testicular dislocations: what we know after two centuries

Subramaniam S, Ab Khalil MK, Zakaria J, Hayati F

BMJ Case Rep, 2020 Nov 03;13(11).

PMID: 33148579 DOI: 10.1136/bcr-2020-236801

Traumatic testicular dislocation (TTD) is a rare consequence of blunt scrotal trauma. A 21-year old gentleman presented with inguinal pain following a motorcycle accident and physical examination revealed absence of both testes within a well-formed scrotal sac with bilateral inguinal swellings. Ultrasonography confirmed viability and location of the testes at the superficial inguinal pouch. He underwent emergent surgical reduction with orchidopexy and was discharged the next day. No evidence of testicular dysfunction or atrophy was noted at follow-up. We reviewed reports of TTDs reported in English over the last two centuries and discuss its occurrence, evolution and management.

Matched MeSH terms: Wounds, Nonpenetrating/complications*; Wounds, Nonpenetrating/diagnosis

Major tracheobronchial injuries: Management of two rare cases

Huei TJ, Lip HTC, Rahmat O

Med J Malaysia, 2018 06;73(3):177-179.

PMID: 29962504 MyJurnal

Tracheobronchial injuries are uncommon and a high level of suspicion is needed for immediate diagnosis and prompt treatment. In this case series, two rare cases of tracheobronchial injuries is described showing variable clinical presentations with different levels of injury. Our first case was seen in a 20 years old male whom had a direct impact on the neck and presented with upper tracheal injury. On arrival, this patient was in respiratory distress and had bilateral pneumothorax. Bilateral chest tube was inserted with subsequent neck exploration. During the neck exploration, anastomosis of the injured trachea was performed. The second case was represented by a 35 years old man with right main bronchial injury. Upon initial presentation, this patient appeared well and was comfortable under room air. However he gradually deteriorated one week after the trauma requiring surgical intervention. Eventually a thoracotomy with primary anastomosis of the bronchial tear was performed. Details of both cases including clinical presentation, imaging and procedures done will be discussed in this article.

Matched MeSH terms: Wounds, Nonpenetrating/surgery; Wounds, Nonpenetrating/therapy

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