Journal of Trauma and Injury最新文献

{"title":"Inferior vena cava injuries at a level I trauma center: six case reports.","authors":"Rachith Sridhar, Abdul Vakil Khan, Harendra Kumar, Abdul Hakeem, Deepak Kumar, Majid Anwer","doi":"10.20408/jti.2025.0054","DOIUrl":"https://doi.org/10.20408/jti.2025.0054","url":null,"abstract":"<p><p>Inferior vena cava (IVC) injuries are rare but deadly. Depending on the mechanism of injury, patient status, and type of injury, intervention may be surgical or endovascular. These injuries typically pose challenges in identification and treatment. During surgical intervention, rapid access and timely control of the bleeding site may be difficult. In this series, we aim to describe various IVC injuries presented at our center, detailing challenges and outcomes in their management. The study aims to characterize the presentation, interventions, and outcomes of IVC injury cases at a level I trauma center over a period of 30 months. In this report, a total of six cases of IVC injury were treated at our center. All patients underwent surgical intervention. Each patient experienced a high-energy trauma mechanism, with three patients sustaining blunt trauma and three sustaining penetrating trauma. Of the six patients, three survived while three died. Mortality was attributed to delayed presentation, complexity of injuries, and technical difficulties. Adherence to Advanced Trauma Life Support (ATLS) protocols, timely diagnosis and resuscitation, and rapid decision-making can reduce mortality associated with IVC injuries. Nonetheless, surgeons must remain cognizant of the inherent challenges and pitfalls in managing these injuries.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509396","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":"Silent ST elevation: unmasking blunt cardiac injury: a case report.","authors":"Vasudha Dinesh, Arun A Mohanan, Swetha Ramesh, Amaravathi Uthayakumar","doi":"10.20408/jti.2025.0034","DOIUrl":"https://doi.org/10.20408/jti.2025.0034","url":null,"abstract":"<p><p>Blunt cardiac injury is a rare but serious complication of thoracic trauma. We present the case of a 22-year-old male pedestrian involved in a road traffic accident (pedestrian vs. four‑wheeler) who was found to have ST‑segment elevation on electrocardiography during trauma evaluation. Despite being hemodynamically stable and lacking clinical signs or symptoms of cardiac injury, his electrocardiography showed ST elevations in the inferior leads. This case underscores the importance of vigilant cardiac monitoring in polytrauma patients, in whom blunt cardiac injury may be easily overlooked.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486926","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":"Spontaneous resolution of papilledema and multilayered hemorrhages in Terson syndrome associated with subarachnoid hemorrhage: a case report.","authors":"Shreyas Temkar, Hemanth Ramachandar, Astha Gupta, Amit Kumar Deb","doi":"10.20408/jti.2024.0097","DOIUrl":"https://doi.org/10.20408/jti.2024.0097","url":null,"abstract":"<p><p>Terson syndrome (TS) is a condition characterized by the association of intraocular hemorrhages with an underlying intracranial bleed. Although it is widely postulated that the condition arises from raised intracranial pressure, the occurrence of papilledema is rarely reported in TS. We present a case involving a 35 year old male patient who developed TS following a head injury. Papilledema was incidentally detected and managed with measures aimed at reducing intracranial pressure. The patient subsequently experienced spontaneous resolution of both the cerebral and ocular hemorrhages, as well as resolution of the papilledema. A dilated fundus examination is strongly recommended for any patient presenting with intracranial hemorrhage (especially subarachnoid hemorrhage) to identify intraocular hemorrhages and papilledema.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486927","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":"Successful minimally invasive reduction surgery with a micro burr hole in a pediatric patient with depressed skull fracture: a case report.","authors":"Seung Han Yu, Hyuk Jin Choi, Byung Chul Kim, Mahn Jeong Ha","doi":"10.20408/jti.2025.0015","DOIUrl":"https://doi.org/10.20408/jti.2025.0015","url":null,"abstract":"<p><p>A 5-year-old female pediatric patient with head trauma was transferred to our regional trauma center. A depressed skull fracture measuring 45 mm in diameter and 6 mm in depth was diagnosed using a 3-dimensional (3D) computed tomography (CT) scan. Despite the absence of significant neurological symptoms, the extent of the depression necessitated surgical intervention on the third day of hospitalization. Using a 2 mm micro burr, two holes were drilled at strategically selected points of the fracture identified by 3D CT. Adson blunt dissecting hooks were inserted through the burr holes to elevate and reduce the fracture. Postoperative CT scans, including a follow-up scan on the 36th day, demonstrated stable reduction. The minimally invasive technique applied for pediatric depressed skull fracture reduction may significantly reduce pain, shorten recovery time, and decrease hospitalization duration, yielding favorable outcomes.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486928","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":"Preperitoneal pelvic packing as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability after the Kocher-Langenbeck approach to the acetabulum: a case report.","authors":"Doo-Hun Kim, Maru Kim, Dae-Sang Lee, Tae Hwa Hong, Hangjoo Cho","doi":"10.20408/jti.2024.0087","DOIUrl":"https://doi.org/10.20408/jti.2024.0087","url":null,"abstract":"<p><p>Pelvic fractures result from high-energy trauma, and when accompanied by hemorrhagic shock, the mortality rate increases to 40%. Pelvic fractures are anatomically categorized as pelvic ring disruptions and acetabular fractures, each requiring different treatment methods and approaches. Acetabular fractures, which also result from high-energy injuries, may be accompanied by hemorrhagic shock. Treatment options for pelvic fractures with hemorrhagic shock include angioembolization, preperitoneal pelvic packing (PPP), and emergency laparotomy. In hemodynamically stable patients, early total care may be attempted, and for acetabular fractures (posterior column), the Kocher-Langenbeck approach is the treatment of choice. This case report describes the use of PPP as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability following a Kocher-Langenbeck approach for an acetabular fracture with pelvic ring injury. The patient was discharged without postoperative complications such as bone displacement or surgical site infection. While PPP is commonly employed as an initial treatment modality for pelvic fractures with hemorrhagic shock, it may also be valuable in managing postoperative retroperitoneal bleeding with hemorrhagic shock.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486925","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":"Complex soft tissue injuries associated with portable charger detonation: four case reports from the war in Ukraine.","authors":"Eduard Mykolaiovych Khoroshun, Vitaliy Volodymyrovych Makarov, Volodymyr Volodymyrovych Nehoduiko, Maksym Olegovych Malimonenko, Hannah B H Wild, Serhii V Tertyshnyi","doi":"10.20408/jti.2025.0042","DOIUrl":"https://doi.org/10.20408/jti.2025.0042","url":null,"abstract":"<p><p>This article describes the characteristics and management of injuries associated with ricochet effects due to portable charger detonation. We present a case series of four military personnel who sustained complex soft tissue injuries when portable chargers detonated after being struck by projectiles during combat. All patients were treated by an advanced surgical team at the Military Medical Clinical Center of the Northern Region in Kharkiv, Ukraine, over a 9-month period in 2023. Patient history, physical examination findings, laboratory studies, radiographic imaging, treatment approaches, and early outcomes were examined. All patients were male, with a mean age of 33±0.3 years. Complex soft tissue injury patterns arose when a projectile (such as a bullet or shrapnel) struck the charger, causing ricochet effects while damaging the battery housing and triggering detonation. The anatomical region of injury corresponded to the charger's placement in the patients' pockets, namely the thigh or buttock. Characteristic findings included local chemical burns of the skin and subcutaneous tissue, with surrounding ecchymosis. Surgical teams identified three zones of damage associated with this injury pattern: (1) a central zone with the most pronounced burn related changes, covering the smallest area of the three zones; (2) an intermediate zone of soft tissue damage from thermochemical reactions extending beyond the charger's profile; and (3) an outer zone of ecchymosis. Risks associated with carrying portable chargers during combat have not been well documented. These findings may inform injury prevention strategies for military personnel.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486923","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":"Dual plating in the management of nonunion complex distal femur fractures following lateral locked plate fixation: radiological and functional outcomes of a prospective study.","authors":"Nilesh Barwar, Gypsy Gargi, Ankit Rai, Abhay Elhence, Sumit Banerjee, Nitesh Gahlot","doi":"10.20408/jti.2024.0054","DOIUrl":"10.20408/jti.2024.0054","url":null,"abstract":"<p><strong>Purpose: </strong>Managing complex distal femur fractures presents technical challenges. Although the lateral locked plate has become standard for these fractures, failures are not uncommon when this device is used alone. Patients with nonunion of distal femur fractures following treatment with a single lateral locked plate were examined. Revision surgery was performed by applying dual plates, and their efficiency was evaluated.</p><p><strong>Methods: </strong>This study investigated 24 aseptic and 3 septic nonunions of distal femur fractures, classified as AO/OTA type C, that were previously managed with open reduction and internal fixation using only a lateral locked plate. Revision surgery involved replacing the broken 5.0-mm lateral locked plate, supplementing the medial side with a 4.5-mm T-plate, and applying bone grafting at the fracture site. Septic cases were managed using a staged approach with dual implant application.</p><p><strong>Results: </strong>Following revision surgery, bony union was achieved in 83.3% of aseptic nonunions, with a mean bone healing time of 22.5 weeks (range, 15-27 weeks). Additional surgery was required for the remaining 16.6%. Using staged management, the septic nonunions were united in a mean of 30.25 weeks (range, 27-32 weeks). Significant improvements were noted in the Tegner Lysholm Knee Scoring Scale, with median preoperative and postoperative scores of 30 (range, 12-67) and 80 (range, 66-90), respectively (P<0.001). Limb pain, as measured by the visual analog scale for knee pain, improved significantly from a preoperative median of 6 (range, 4-8) to 3 (range, 1-6) postoperatively (P<0.001). All patients were ambulatory without supportive devices. However, the mean knee range of motion was 80° (range, 40°-120°). Limb shortening was observed in six cases (22.2%; average shortening, 2.3±1.0 cm).</p><p><strong>Conclusions: </strong>Dual plating appears to be an effective approach for managing failed complex distal femur fractures following initial treatment with a single lateral locked plate.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":"125-136"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509395","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":"Surgical site infections: a comprehensive review.","authors":"Ahmad Reza Rezaei, Damian Zienkiewicz, Amir Reza Rezaei","doi":"10.20408/jti.2025.0019","DOIUrl":"10.20408/jti.2025.0019","url":null,"abstract":"<p><p>Surgical site infections (SSIs) represent a major public health challenge, contributing to increased morbidity, mortality, and healthcare costs worldwide. This paper presents a comprehensive review of the epidemiology, classification, risk factors, microbiological aspects, treatment modalities, and prevention strategies for SSIs, based on contemporary research and evidence-based practice protocols. An extensive literature review was conducted, synthesizing existing studies on SSIs. A comprehensive search was performed in PubMed, Embase, Cochrane Library, and guidelines from leading organizations such as the American College of Surgeons, the US Centers for Disease Control and Prevention, the World Health Organization, and the Infectious Diseases Society of America. Inclusion criteria encompassed peer-reviewed articles as well as American and European medical guidelines focusing on the epidemiology, risk factors, microbiology, treatment, and prevention of SSIs. The review adhered to the PECO (population, exposure, comparator, outcome) framework. Some of the most significant global concerns related to SSIs include antibiotic resistance and the contamination of surgical instruments, particularly in resource-poor settings. Trauma patients, especially those undergoing emergency procedures or sustaining open fractures, are at increased risk for SSIs due to the severity of their injuries and higher contamination risks. These findings underscore the importance of preventive measures, such as appropriate preoperative interventions, strict aseptic techniques, and proper antibiotic prophylaxis, in reducing SSI incidence and improving patient outcomes.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":"71-81"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144509397","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":"Management and outcomes of open and endovascular aortic repair with blunt traumatic aortic injuries in Western Australia.","authors":"Amyna Jiwani, Warren D Raymond, Fernando Picazo-Pineda, Sudhakar Rao, Kishore Sieunarine","doi":"10.20408/jti.2024.0101","DOIUrl":"10.20408/jti.2024.0101","url":null,"abstract":"<p><strong>Purpose: </strong>Blunt traumatic aortic injuries (TAIs) require timely surgical intervention to prevent death. We described the management and outcomes of polytrauma patients with TAI after open and endovascular repair in Western Australia.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of patients with TAI admitted to the State Trauma Unit, Royal Perth Hospital from 2008 to 2018. Patient data were obtained from the Trauma Database and supplemented with chart review.</p><p><strong>Results: </strong>Among 57 patients with TAI, 45 (78.9%) were male, with a mean age of 41 years, and were mainly involved in motor vehicle crashes (89.5%). They had a median Injury Severity Score of 34 (interquartile range [IQR], 21-45) and a median length of stay of 18 days. Concurrent injuries occurred in nearly all patients, including musculoskeletal (56 patients, 98.2%; mainly fractures, 91.2%), central nervous system (33 patients, 57.9%; mostly hemorrhage), injury to the chest cavity (46 patients, 80.7%), and abdominal organs (32 patients, 56.1%). The most common TAI grade was III (56.1%), followed by grade I (22.8%) and grade II (21.1%); all grade IV patients died before vascular consultation. TAI was managed with endovascular surgery (thoracic endovascular aortic repair, TEVAR) in 37 (64.9%, of which early TEVAR was performed in 29 [78.4%]), open surgery in 4 (7.0%), and conservative management in 16 (28.1%). Vascular procedures had a median duration of 81 minutes (IQR, 60-97 minutes). Acute vascular surgery-related complications were infrequent (5.3%), and all occurred post-TEVAR, mainly involving upper limb ischemia that required bypass or stenting within 72 hours of the index procedure. After discharge (52 patients), 3 patients were lost to follow-up regarding surgical survival, and late complications occurred in 6 of 48 vascular surgery patients (12.5%), who all underwent TEVAR.</p><p><strong>Conclusions: </strong>TAI patients who received a vascular surgery review and were managed either conservatively or surgically showed favorable postdischarge survival rates and surgical results. Patients with grade II or III TAI who underwent endovascular repair had favorable short- and long-term outcomes.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":"38 2","pages":"111-124"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555695","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":"Resolution is not the end: The Macklin effect after chest tube removal in a trauma patient with aging and comorbidities: a case report.","authors":"Faye Abdulkareem, Fayez G Aldarsouni, Sahar Alomar, Zisis Touloumis, Hussain M AlHassan, Ghassan Z Al Ramahi, Tareq Alsabahi, Khaled Twier, Mohammad Alsenani, Emad Alamoudi","doi":"10.20408/jti.2024.0090","DOIUrl":"10.20408/jti.2024.0090","url":null,"abstract":"<p><p>Pneumomediastinum is an uncommon complication in cases of blunt chest trauma but can signal severe underlying issues. This report discusses a 69-year-old male patient with preexisting conditions of obesity, sleep apnea, and asthma, who experienced delayed pneumomediastinum and pneumopericardium following the removal of a chest tube. This tube had been placed to address a traumatic hemopneumothorax, which had resolved. The removal of the chest tube triggered a series of events, exacerbated by the patient's chronic health conditions. The patient was managed conservatively with close monitoring and physiotherapy, which successfully resolved the condition without the need for further invasive procedures. The multifactorial nature of the Macklin effect illustrates that even routine procedures such as chest tube removal can trigger a chain reaction in susceptible patients. The choice of conservative management, rather than immediate invasive interventions, underscores the delicate balance necessary in trauma care.</p>","PeriodicalId":52698,"journal":{"name":"Journal of Trauma and Injury","volume":" ","pages":"159-164"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12229809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702212","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}