Journal of Trauma and Injury最新文献

{"title":"Changes in the characteristics of civilian patients admitted to a military hospital before and during the healthcare system crisis: a retrospective cohort study.","authors":"Changsin Lee, Sang Mok Lee, Kyungwon Lee","doi":"10.20408/jti.2025.0096","DOIUrl":"10.20408/jti.2025.0096","url":null,"abstract":"<p><strong>Purpose: </strong>In February 2024, a healthcare system crisis in Korea, triggered by the mass resignation of medical residents in protest of government medical policies, resulted in an increased influx of civilian trauma patients to a military trauma center. This study examines the scale, characteristics, and treatment outcomes of these patients before and during the crisis.</p><p><strong>Methods: </strong>A retrospective review was conducted, comparing civilian trauma patients who visited the center from March 2023 to February 2024 (before crisis) and from March 2024 to February 2025 (during the crisis). The variables analyzed included patient demographics, injury types, methods of transportation, length of emergency room (ER) stay, hospitalization outcomes, and final treatment results. Only civilian trauma patients who required hospitalization were included; mild cases discharged from the ER were excluded.</p><p><strong>Results: </strong>A total of 548 civilian patients visited the center during the study period, with a significant increase observed during the crisis (364 patients during the crisis vs. 81 patients before the crisis). Despite the surge, there were no significant differences in hospital arrival routes, methods of transportation, mechanisms of injury, or injury types. ER stay durations were shorter for both general and severe cases during the crisis (P=0.020 and P=0.033, respectively), although intensive care unit and overall hospital stay lengths remained unchanged. Civilian outpatient visits increased more than threefold in March 2024 compared to February 2024, and this elevated trend remained stable.</p><p><strong>Conclusions: </strong>These findings highlight the military trauma center's ability to maintain effective civilian trauma care despite significant healthcare system disruptions. The study underscores the resilience of the center and offers insights for optimizing trauma care operations in future crises.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":"14-24"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13040095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascularized tissue coverage of trauma and acute care surgery defects with ovine forestomach matrix: interim results of a prospective multicenter study.","authors":"Michael T Cormican, W Matthew Vassy, Carolyn Cook, Christopher A Butts, John Loftus, Jessica Simon, D Adam Young, Alison A Smith","doi":"10.20408/jti.2025.0090","DOIUrl":"10.20408/jti.2025.0090","url":null,"abstract":"<p><strong>Purpose: </strong>Traumatic soft tissue defects present challenges due to their diverse presentations. This variability necessitates tailored approaches for effective management, requiring advanced reconstruction strategies to achieve rapid coverage and tissue infill while minimizing complications. The study aimed to evaluate the safety of ovine forestomach matrix (OFM) grafts in traumatic defects from four level I trauma centers.</p><p><strong>Methods: </strong>This prospective observational study used a multicenter registry to collect deidentified data from adult trauma/acute care surgery patients who received OFM-based grafts for soft tissue repair from August 2022 through September 2024. After the application of OFM grafts, defects were regularly assessed for the development of vascularized tissue coverage and/or fill, and ultimately epithelialization.</p><p><strong>Results: </strong>During the study, 49 participants with 61 soft tissue defects underwent procedures with OFM-based grafts. The mean participant age was 58.8±17.7 years. Most defects (55.7%) resulted from traumatic injuries, with additional etiologies including necrotizing soft tissue infections (13.1%), enterocutaneous fistulas (4.9%), acute pressure injuries (stages III and IV, 6.6%), surgical dehiscence (4.9%), amputations (3.3%), and hematoma evacuation (3.3%). All defects achieved vascularized tissue coverage within a median of 22.5 days (interquartile range, 13.3-33.5 days) after a median of one product application (interquartile range, 1-1). Four cases of superficial infection were reported, all resolving without major complications.</p><p><strong>Conclusions: </strong>OFM-based grafts showed promising results in tissue regeneration for trauma and acute care defects, with minimal postoperative complications. These results are interim findings from an ongoing prospective multicenter registry study evaluating the safety and efficacy of OFM-based grafts in various surgical applications.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":"42-51"},"PeriodicalIF":0.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13040089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146004576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated orbital roof fracture with concurrent orbital compartment syndrome: a case report.","authors":"Khalifa Al Alawi, Sondus Al Jadeedi, Sultan Al Shaqsi, Meera Sahib, Taimoor Al Balushi","doi":"10.20408/jti.2025.0070","DOIUrl":"https://doi.org/10.20408/jti.2025.0070","url":null,"abstract":"<p><p>Isolated orbital roof fractures are rare, accounting for less than 0.2% of all facial fractures. They usually result from high-velocity impacts and are frequently associated with additional facial, ocular, and neurological trauma, necessitating a multidisciplinary team approach. In this report, we present a case of an isolated orbital roof fracture complicated by orbital compartment syndrome, severe proptosis, vision loss, corneal abrasion, subdural hemorrhage, and a dural tear. Surgical intervention was initially delayed due to logistical constraints. Ultimately, fracture reduction and orbital roof reconstruction were successfully performed using a split calvarial bone graft. Postoperatively, there was marked improvement in proptosis and visual function; however, the patient continued to experience residual visual impairment due to corneal laceration. Although less common, orbital roof fractures represent a potentially serious form of craniofacial trauma. Standardized treatment protocols remain difficult to establish, given the rarity of such injuries. Repair methods are primarily directed at separating intracranial from intraorbital contents. A coordinated interdisciplinary approach involving plastic surgery, ophthalmology, and neurosurgery is essential for comprehensive patient management.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145858929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in severe injuries of child and adolescent pedestrians in child protection zones after the revision of the Road Traffic Act in Korea: a retrospective nationwide observational study.","authors":"Eun Sook Ryu, Jae Ho Jang, Jae Yeon Choi, Woo Sung Choi, Sung Youl Hyun","doi":"10.20408/jti.2025.0255","DOIUrl":"10.20408/jti.2025.0255","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to analyze changes in injury severity among child pedestrians following the implementation of the revised Road Traffic Act (the \"Minsik Law\") in Korea's child protection zones on March 25, 2020.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using the nationwide Emergency Department-based Injury In-depth Surveillance (EDIIS) database. The pre-amendment period (January 2018 to February 2020; n=1,480) was compared with the post-amendment period (March 2021 to December 2023; n=1,085) for pedestrian accident patients under 13 years of age, applying a 1-year washout period to mitigate the effects of the COVID-19 pandemic. The primary outcome was severe injury, defined as an Injury Severity Score (ISS) of ≥15. Multivariate logistic regression was used for the assessment.</p><p><strong>Results: </strong>A total of 2,565 patients were included. The proportion of severe injuries (ISS ≥15) decreased from 63.1% to 53.6% after the amendment, although this trend did not reach statistical significance (P=0.085). However, after adjustment for age, sex, and other variables, multivariate analysis showed that the post-amendment period was independently associated with a significant 38.4% reduction in the odds of severe injury (adjusted odds ratio, 0.616; P<0.001). A significant shift in the distribution of injury sites was also noted (P<0.005).</p><p><strong>Conclusions: </strong>The revision of the Road Traffic Act was significantly associated with reduced injury severity among child pedestrians in Korea. These findings provide strong evidence supporting the policy's effectiveness in improving clinical outcomes and strengthening child safety.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":"38 4","pages":"366-372"},"PeriodicalIF":0.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhaled amikacin as a preventive strategy against ventilator-associated pneumonia in a trauma intensive care unit: early evidence from a single-center retrospective cohort study.","authors":"Ohchul Kwon, Nahyeon Lee, Seok Hwa Youn, Younghwan Kim, Mina Kim, Jinho Jheong, Gaesung Ha, Youngwoong Kim","doi":"10.20408/jti.2025.0145","DOIUrl":"10.20408/jti.2025.0145","url":null,"abstract":"<p><strong>Purpose: </strong>Ventilator-associated pneumonia (VAP) remains a leading cause of morbidity and mortality in intensive care units (ICUs). The effectiveness of prophylactic inhaled amikacin in preventing VAP remains uncertain. This study compared VAP incidence between patients with trauma who received prophylactic inhaled amikacin and those who did not.</p><p><strong>Methods: </strong>We conducted a retrospective, single-center analysis of 66 mechanically ventilated trauma patients admitted to the ICU between May and December 2024. Primary outcomes were infection-related ventilator-associated conditions (IVAC) and microbiologically confirmed VAP. Secondary outcomes included mechanical ventilation duration, ICU and hospital length of stay, and 30-day mortality. Statistical analyses comprised chi-square tests, multivariate logistic regression, and Cox proportional hazards regression with propensity score matching.</p><p><strong>Results: </strong>A total of 66 patients were included: 28 in the prophylaxis group and 38 in the control group. The prophylaxis group demonstrated a higher unadjusted incidence of IVAC (85.71% vs. 55.26%, P=0.02) and VAP (82.14% vs. 44.74%, P<0.01) compared with the control group. However, after adjustment, logistic regression revealed no significant association between inhaled amikacin and increased risk of VAP (odds ratio [OR], 3.00; 95% confidence interval [CI], 0.80-12.81; P=0.11) or IVAC (OR, 3.10; 95% CI, 0.71-16.43; P=0.15). Similarly, Cox regression analysis showed no significant effect on VAP (hazard ratio [HR], 1.10; 95% CI, 0.47-2.58; P=0.82) or IVAC (HR, 1.68; 95% CI, 0.78-3.59; P=0.18). Secondary outcomes did not differ significantly between groups.</p><p><strong>Conclusions: </strong>Prophylactic inhaled amikacin neither prevented nor increased IVAC and VAP risk in mechanically ventilated trauma patients, suggesting no meaningful impact on VAP outcomes in this population.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":"38 4","pages":"343-352"},"PeriodicalIF":0.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment strategy for acute blunt traumatic abdominal wall injury: a single-center retrospective study in Korea.","authors":"Gun Woo Kim, Chang-Yeon Jung, Sung Hoon Cho, Suyeong Hwang, Kyoung Hoon Lim","doi":"10.20408/jti.2025.0234","DOIUrl":"10.20408/jti.2025.0234","url":null,"abstract":"<p><strong>Purpose: </strong>Traumatic abdominal wall hernia, a rare condition resulting from blunt trauma, is characterized by disruption of the abdominal wall musculature and fascia without skin penetration. Given its rarity, standardized treatment guidelines are lacking, and the necessity for immediate surgery remains debated. This study examines high-energy posterolateral abdominal wall injuries (AWI), which pose significant management challenges due to their anatomical complexity and high recurrence risk.</p><p><strong>Methods: </strong>We retrospectively reviewed records of 44 adults with grade III-VI AWI treated between 2013 and 2023 at a level I trauma center. Patients were categorized into emergency repair or delayed management groups based on the initial treatment strategy, with injuries anatomically classified as anterior, lateral, or posterolateral. Nonoperative management (NOM) was limited to patients without herniation on index imaging and entailed close observation with regular follow-up imaging.</p><p><strong>Results: </strong>AWI was identified in 44 of 83,532 patients (0.05%) with blunt trauma. Anatomically, 4 cases (9.1%) were anterior, 17 (38.6%) were lateral, and 23 (52.3%) were posterolateral. Three patients (6.8%) were classified as grade III injury, 16 (36.4%) as grade IV, 24 (54.6%) as grade V, and 1 (2.3%) as grade VI. Emergency repair was performed in 26 patients (59.1%), whereas 18 (40.9%) initially received delayed management. In the latter group, 8 of 18 patients (44.4%) were judged to require delayed repair, of whom six proceeded to surgery. Among 10 NOM patients with indeterminate muscle-layer integrity on initial imaging due to hematoma or tissue injury, follow-up revealed delayed hernia development in three, while seven had resolved hematoma, confirming wall integrity.</p><p><strong>Conclusions: </strong>In hemodynamically stable patients with traumatic posterolateral AWI without herniation, NOM with close monitoring and delayed repair for subsequent hernia appears safe and effective as an alternative to immediate surgery. Management should be tailored to injury location and patient condition. These findings inform the management timing and approach for this rare, challenging injury pattern.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":"38 4","pages":"373-381"},"PeriodicalIF":0.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous phase extravasation on computed tomography is a red flag sign in critical/severe pelvic injuries.","authors":"Hong Kyung Shin, Chami Im, Hye Rim Shin, Mi Jeong Choi, Jung-Woo Woo","doi":"10.20408/jti.2025.0198","DOIUrl":"10.20408/jti.2025.0198","url":null,"abstract":"<p><strong>Purpose: </strong>Managing hemodynamically unstable patients with pelvic fractures is highly challenging, particularly when vascular injuries are present, as these can significantly worsen prognosis. This study evaluated outcomes in patients with pelvic trauma and vascular injuries prior to the introduction of preperitoneal pelvic packing.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of 195 patients with pelvic injuries who presented to the emergency room of our hospital between May 2003 and August 2013.</p><p><strong>Results: </strong>Among the 195 patients, 34 had vascular injuries and 161 had nonvascular injuries. The vascular injury group had significantly higher transfusion rates (82.4% vs. 11.8%, P<0.001) and required a greater mean number of packed red blood cell units than the nonvascular group (5.2±5.5 vs. 0.4±1.4, P<0.001). Subgroup analysis within the vascular injury cohort revealed significant differences between patients with venous phase extravasation (n=5) and those with isolated arterial phase extravasation (n=29) in median packed red blood cell units transfused (12.5 units vs. 3 units; P=0.014), cardiac arrest rate (80.0% vs. 10.3%, P=0.003), and mortality rate (60.0% vs. 10.3%, P=0.029). Notably, patients with isolated venous extravasation showed a significantly higher mortality rate compared to those with isolated arterial extravasation (100% vs. 10.3%, P=0.004).</p><p><strong>Conclusions: </strong>Venous phase extravasation was associated with higher transfusion requirements, cardiac arrest incidence, and mortality compared to arterial extravasation.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":"38 4","pages":"360-365"},"PeriodicalIF":0.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Catastrophic complications from inadequate early soft tissue surveillance in a closed pilon fracture: a case report.","authors":"Jeong-Hyun Koh, Sumin Lim, Hyung Keun Song, Wan-Sun Choi, Won-Tae Cho, Seungyeob Sakong","doi":"10.20408/jti.2025.0158","DOIUrl":"10.20408/jti.2025.0158","url":null,"abstract":"<p><p>We present the case of a 55-year-old man with an AO/OTA 43-C3 pilon fracture in whom initial uniplanar external fixation failed to relieve persistent medial skin tenting, resulting in focal ischemic necrosis. Within 72 hours, the patient developed bullae and violaceous discoloration, which progressed to full-thickness skin breakdown. Despite staged open reduction and internal fixation and fasciocutaneous flap coverage, the patient developed chronic osteomyelitis, ultimately requiring segmental bone resection to control the infection. The patient underwent serial debridement procedures and placement of antibiotic-loaded cement spacers. Definitive reconstruction was achieved with salvage tibiotalocalcaneal arthrodesis using the Expert Tibial Nail system on postoperative day 319. Twelve months after fusion and bone grafting, radiographs confirmed solid union, and the patient was ambulating independently, albeit with considerable long-term functional limitations. This case underscores the importance of early and meticulous soft tissue evaluation in high-energy pilon fractures. Prompt repositioning of fracture fragments or the use of adjunctive decompression is essential. Delayed or inadequate decompression can lead to a cascade of complications, beginning with soft tissue necrosis and progressing to deep infection and limb salvage fusion, even when standard fixation protocols are followed.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":"38 4","pages":"404-411"},"PeriodicalIF":0.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale (GCS) for predicting outcomes in traumatic brain injury: a comparative study.","authors":"Harsh Jain, Jishnu N Nair, Davuluri Venkata Shashank, Visvanathan Krishnaswamy, Krishnamurthy Ganesh","doi":"10.20408/jti.2025.0125","DOIUrl":"10.20408/jti.2025.0125","url":null,"abstract":"<p><strong>Purpose: </strong>Traumatic brain injuries (TBIs) are a leading cause of morbidity, mortality, socioeconomic loss, and diminished quality of life among survivors of all injury types. The Glasgow Coma Scale (GCS), though commonly used in the intensive care unit (ICU), has limitations that may be addressed by the Full Outline of Unresponsiveness (FOUR) score. We compared the ability of the FOUR and GCS scores to predict outcomes in patients with TBI.</p><p><strong>Methods: </strong>This prospective observational study included all patients presenting with head injury who survived beyond 24 hours between 2020 and 2022. Basic demographic data, prehospital care details, and neurological findings were collected. TBI severity was assessed using both the GCS and FOUR scores, and outcomes were graded using the Glasgow Outcome Score (GOS).</p><p><strong>Results: </strong>Among 225 patients (mean age, 42.4±19.7 years; male sex, 77.8%) with TBIs, the mortality rate was 4.4%, and 15.1% experienced a poor outcome (GOS ≤2). Receiver operating characteristic curve analysis showed good predictive ability for both the FOUR score (area under the curve [AUC], 0.85) and GCS (AUC, 0.88). FOUR score ≤12 and GCS ≤10 were identified as optimal cutoff values for predicting poor outcomes (P<0.001), with the FOUR score demonstrating sensitivity and specificity of 79.4% and 77.5%, respectively. A FOUR score ≤12 at admission was significantly associated with intubation (odds ratio [OR], 8.2; 95% confidence interval [CI], 4.6-14.4; P<0.001), tracheostomy (OR, 21.8; 95% CI. 6.9-68.8; P<0.001), and neurological complications, including mental function deficits (OR, 7.5; 95% CI, 3.2-17.7; P<0.001), cranial nerve palsy (OR, 4.1; 95% CI, 1.6-10.4; P=0.002), and motor deficits (OR, 9.4; 95% CI, 4.6-19.2; P<0.001). A strong correlation was observed between the FOUR score and GOS (r=0.7).</p><p><strong>Conclusions: </strong>The FOUR score is a reliable tool for assessing TBI severity and predicting outcomes, with performance comparable to the GCS. An admission FOUR score ≤12 was associated with poor neurological outcomes, increased need for advanced airway management, and long-term disability. By capturing additional neurological parameters beyond the GCS, the FOUR score may offer clinical advantages in ICU settings for early prognostication and management of patients with TBI.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":"38 4","pages":"327-334"},"PeriodicalIF":0.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thirteen-year trend analysis of orbital blowout fractures: shifts in mechanisms and ocular sequelae across two Korean trauma centers (2011-2023).","authors":"Minhee Hwang, Youngjun Kim, Changryul Claud Yi","doi":"10.20408/jti.2025.0164","DOIUrl":"10.20408/jti.2025.0164","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to examine 13-year changes in the injury mechanisms of orbital blowout fractures (OBFs) in Korea and to determine how those changes influenced preoperative ocular motility deficits, while also assessing whether apparent intercenter differences persisted after covariate adjustment.</p><p><strong>Methods: </strong>A retrospective cohort was assembled from two level I trauma centers: a historical 2011 series from Inje University Sanggye Paik Hospital (n=150) and a pooled 2019-2023 series from Pusan National University Hospital (n=50). Eligibility required computed tomography-confirmed medial and/or inferior wall fracture with an intact orbital rim; patients with rim involvement or penetrating ocular trauma were excluded. Injury mechanism, fracture site, and diplopia and/or extraocular movement (EOM) limitation at presentation were abstracted from electronic medical records. Categorical comparisons used the chi-square test, and trends across calendar years were assessed using logistic regression (with year as a continuous predictor). Multivariable logistic modeling estimated adjusted odds ratios (aORs) for preoperative ocular motility deficit according to age, sex, mechanism, fracture site, calendar year, and center, with robust clustering.</p><p><strong>Results: </strong>Interpersonal violence decreased from 34.7% of OBFs in 2011 to 14.0% in 2019-2023, representing an 11% annual decline (OR, 0.89; 95% confidence interval [CI], 0.81-0.97, P=0.007). Preoperative diplopia or EOM limitation was observed in 23 of 200 patients (11.5%): 14% in 2011 versus 4% in 2019-2023. Independent predictors of EOM limitation were interpersonal violence (aOR 3.84; 95% CI, 1.38-10.65; P=0.010) and male sex (aOR, 4.78; 95% CI, 1.49-15.49; P=0.009). Age showed a protective trend (aOR, 0.75 per decade; P=0.064); fracture extent and center were not significant after adjustment. Calendar year showed a borderline inverse association (aOR, 0.86; P=0.061), indicating a 14% annual reduction in presentation-time deficit.</p><p><strong>Conclusions: </strong>Between 2011 and 2023, the Korean OBF landscape shifted from violent assault to accidental mechanisms, accompanied by a marked decline in preoperative ocular motility impairment. Assault mechanism and male sex remain strong risk indicators, while center-based differences appear largely explained by temporal composition. Public health efforts that reduce violence may therefore translate directly into better functional status at initial presentation.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":"38 4","pages":"353-359"},"PeriodicalIF":0.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12800520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}