Journal of Trauma and Injury

Case Report

Blunt traumatic right-sided pericardial rupture without cardiac injury: a case report: Muhyung Heo, Hyung Won Kim, Sanghyun Sung; J Trauma Inj. 2026;39(2):178-181. Published online April 1, 2026; DOI: https://doi.org/10.20408/jti.2025.0112

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Abstract PDF: Blunt traumatic pericardial rupture is an exceptionally rare condition, often associated with high morbidity and mortality. Isolated pericardial rupture without vascular or cardiac involvement accounts for only 17% of reported cases. We describe a rare case of right-sided pericardial rupture following blunt chest trauma, an unusual presentation since most pericardial tears occur on the left side. A 23-year-old woman involved in a motor vehicle accident sustained multiple injuries, including right hemothorax, bilateral pulmonary contusions, left-sided rib fractures, and a humerus fracture. Although preoperative computed tomography showed no diagnostic findings, persistent bleeding from the right chest tube prompted exploratory thoracotomy. Intraoperative evaluation revealed a 10-cm right pericardial tear extending from the superior vena cava to the inferior vena cava, with no associated cardiac injury. Surgical management included primary closure of the pericardial tear and repair of adjacent pleural injuries. Postoperatively, the patient developed right diaphragmatic palsy due to phrenic nerve involvement. Pericardial rupture is challenging to diagnose, but in this case, persistent hemothorax facilitated early recognition and intervention. Prompt identification allowed timely surgical repair, likely preventing life-threatening complications such as cardiac herniation. This case highlights the importance of considering pericardial rupture in patients with blunt chest trauma presenting with unexplained clinical findings and underscores the value of early surgical management.; Summary

Original Articles

Treatment strategy for acute blunt traumatic abdominal wall injury: a single-center retrospective study in Korea: Gun Woo Kim, Chang-Yeon Jung, Sung Hoon Cho, Suyeong Hwang, Kyoung Hoon Lim; J Trauma Inj. 2025;38(4):373-381. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0234

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Abstract PDF: Purpose
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.
Methods
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.
Results
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.
Conclusions
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.; Summary

Blunt abdominal trauma: a retrospective study on clinical insights and treatment outcomes: Anurag Kumar, Rachith Sridhar, Harendra Kumar, Abdul Hakeem S., Abdul Vakil Khan, Majid Anwer; J Trauma Inj. 2025;38(3):221-231. Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0045

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5 Citations

Abstract PDF

Purpose
Blunt abdominal trauma is a significant cause of morbidity and mortality, predominantly affecting younger male patients. Therefore, a study examining the mechanisms of injury, injury patterns, and outcomes in these cases is essential. The aim of this study was to evaluate demographics, injury mechanisms, treatments provided, and outcomes in cases of blunt abdominal trauma at a level I trauma center in Eastern India.
Methods
A descriptive retrospective study was conducted at a level I trauma center using departmental audit data spanning 18 months (July 2022–December 2023). Data from 118 patients diagnosed with blunt abdominal trauma were analyzed.
Results
The study revealed a pronounced male predominance (6.35:1), with a mean age of 30.2 years. Road traffic accidents were the most frequent cause of injury (56.8%). Only six patients (5.1%) presented within the "golden hour," resulting in delayed interventions. Surgical intervention was necessary in 78 cases (66.1%), with hollow viscus perforation being the most common indication. The mean hospital stay was 10.6 days, and the overall mortality rate was 12.7%. The presence of shock upon admission significantly correlated with mortality (P<0.001).
Conclusions
Blunt abdominal trauma continues to represent a critical healthcare challenge, particularly affecting younger males. Improved healthcare accessibility, adherence to Advanced Trauma Life Support protocols, and timely interventions could improve survival rates.

Summary

Citations

Citations to this article as recorded by

Advances in abdominal wall imaging: The potential role of cinematic rendering
Zahra F. Rahmatullah, Elliot K. Fishman
Emergency Radiology.2026;[Epub] CrossRef
Non-operative management of blunt abdominal trauma in a tertiary sub-Saharan surgical department: a retrospective cross-sectional analysis of 19 cases
Jacques Noel Tendeng, Armel Franck Tene Nde, Guillaume Tcheutchoua Soh, Diago Anta Dia, Latyr Diagne, Mohamed Lamine Diao, Philippe Manyacka Ma Nyemb, Ibrahima Konate
International Journal of Surgery: Global Health.2026;[Epub] CrossRef
An Unusual Case of Penetrating Abdominal Trauma With Important Clinical Lessons
Girish Bakhshi, Ranjitha R Maiyya, Chandrakant Sabale, Shweta Tungal, Swapnil Bhagat
Cureus.2026;[Epub] CrossRef
Diagnostic Challenges and Management of Blunt Traumatic Duodenal Diverticulum Perforation: A Systematic Review
Maciej Rybicki, Bartłomiej Białas, Karol Kamil Kłosiński, Zbigniew Włodzimierz Pasieka, Bartosz Marek Czyżewski, Piotr Tomasz Arkuszewski
Journal of Clinical Medicine.2026; 15(11): 4390. CrossRef
Pearls and pitfalls in the imaging of blunt bowel and mesenteric injury
Irfan Amir Kazi, Mohamed Elbanan, Ayman Gaballah, Amr Abdelaziz, Nanda Deepa Thimmappa, Bareen Waseem Kabir, Ayesha Nasrullah, Joe Jose, Verghese George, Vivek Yagnik, Rushabh Dev, M. Azfar Siddiqui
Abdominal Radiology.2026;[Epub] CrossRef

Management and outcomes of open and endovascular aortic repair with blunt traumatic aortic injuries in Western Australia: Amyna Jiwani, Warren D. Raymond, Fernando Picazo-Pineda, Sudhakar Rao, Kishore Sieunarine; J Trauma Inj. 2025;38(2):111-124. Published online June 30, 2025; DOI: https://doi.org/10.20408/jti.2024.0101

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Abstract PDF Supplementary Material: Purpose
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.
Methods
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.
Results
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.
Conclusions
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.; Summary

Case Report

Silent ST elevation: unmasking blunt cardiac injury: a case report: Vasudha Dinesh, Arun A. Mohanan, Swetha Ramesh, Amaravathi Uthayakumar; J Trauma Inj. 2025;38(3):294-298. Published online June 25, 2025; DOI: https://doi.org/10.20408/jti.2025.0034

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Abstract PDF: 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.; Summary

Original Article

Validation of chest trauma scoring systems in polytrauma: a retrospective study with 1,038 patients in Korea: Hongrye Kim, Mou Seop Lee, Su Young Yoon, Jonghee Han, Jin Young Lee, Junepill Seok; J Trauma Inj. 2024;37(2):114-123. Published online May 9, 2024; DOI: https://doi.org/10.20408/jti.2023.0087

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7 Citations

Abstract PDF Supplementary Material

Purpose
Appropriate scoring systems can help classify and treat polytrauma patients. This study aimed to validate chest trauma scoring systems in polytrauma patients.
Methods
Data from 1,038 polytrauma patients were analyzed. The primary outcomes were one or more complications: pneumonia, chest complications requiring surgery, and mortality. The Thoracic Trauma Severity Score (TTSS), Chest Trauma Score, Rib Fracture Score, and RibScore were compared using receiver operating characteristic (ROC) analysis in patients with or without head trauma.
Results
In total, 1,038 patients were divided into two groups: those with complications (822 patients, 79.2%) and those with no complications (216 patients, 20.8%). Sex and body mass index did not significantly differ between the groups. However, age was higher in the complications group (64.1±17.5 years vs. 54.9±17.6 years, P<0.001). The proportion of head trauma patients was higher (58.3% vs. 24.6%, P<0.001) and the Glasgow Coma Scale score was worse (median [interquartile range], 12 [6.5–15] vs. 15 [14–15]; P<0.001) in the complications group. The number of rib fractures, the degree of rib fracture displacement, and the severity of pulmonary contusions were also higher in the complications group. In the area under the ROC curve analysis, the TTSS showed the highest predictive value for the entire group (0.731), head trauma group (0.715), and no head trauma group (0.730), while RibScore had the poorest performance (0.643, 0.622, and 0.622, respectively)
Conclusions
Early injury severity detection and grading are crucial for patients with blunt chest trauma. The chest trauma scoring systems introduced to date, including the TTSS, are not acceptable for clinical use, especially in polytrauma patients with traumatic brain injury. Therefore, further revisions and analyses of chest trauma scoring systems are recommended.

Summary

Citations

Citations to this article as recorded by

Evaluation and Proposed Refinement of the Thoracic Trauma Severity Score: Improving Prognostic Accuracy in Blunt Chest Trauma Including Polytrauma Patients
Noha Mohamed Ashraf Fouda, Nour El-Din Noaman Gwely, Gehad Ibrahim Awad, Mohammed Abdelfattah Sanad
European Journal of Cardio-Thoracic Surgery.2026;[Epub] CrossRef
Accurate, fair, and generalisable scaling of injury severity score-based AI with demographics in terms of mortality in patients with trauma: multi-centre, multi-national retrospective cohort study
Yunjeong Choi, Junepill Seok, Thomas Young-Chul Oh, Jeremy Hsu, Do Wan Kim, Byungchul Yu, Jayun Cho, Woocheol Jang, Jina Kim, Na-eun Oh, Jehyeuk Ahn, Robert J. Femia, Paul A. Testa, Dong Keon Yon, Daniel K. Sodickson, Wu Seong Kang, Jinseok Lee
eBioMedicine.2026; 126: 106206. CrossRef
Development and validation of a prediction model for respiratory complications and in-hospital mortality in trauma patients
Do Wan Kim, Dongjin Yeo, Juyeong Kim, Yerin Hwang, Hyunjee Kim, Seung Ha Hwang, Jaeyu Park, Jinseok Lee, Jaehyeong Cho, Selin Woo, Junepill Seok, Byungchul Yu, Youngmin Kim, Sebeom Jeon, Dong Keon Yon, Wu Seong Kang
Scientific Reports.2026;[Epub] CrossRef
Role of the Chest Trauma Scoring System as a Predictor of Mortality and Morbidity and as a Prognostic Tool in Thoracic Trauma Patients: A Prospective Observational Study
Sruthi R. Pillai, Ramu Remanan, Vigy Georgekutty Vazhakalayalil
Amrita Journal of Medicine.2026;[Epub] CrossRef
Lateral implosion injuries: Epidemiology, outcomes and evaluation of the Ch-Sh classification
Joseph E. Hughes-Gooding, Liam Alcock, Peter T.M. Clarke, William J. Hunt, John G. Edwards
Journal of Trauma and Acute Care Surgery.2026;[Epub] CrossRef
Clinical and instrumental diagnosis of combined fractures of the clavicle and ribs
O.A. Burianov, V.Р. Kvasha, M.V. Кrаvchuk, D.V. Miasnikov
EMERGENCY MEDICINE.2025; 21(8): 800. CrossRef
Clinical prediction models for the management of blunt chest trauma in the emergency department: a systematic review
Ceri Battle, Elaine Cole, Kym Carter, Edward Baker
BMC Emergency Medicine.2024;[Epub] CrossRef

Case Reports

A rare and unique experience of a blunt intrathoracic traumatic injury of the trachea and its management in South Africa: a case report: Rudo Mutsa Vanessa Pswarayi, Anna Katariina Kerola; J Trauma Inj. 2023;36(4):416-420. Published online November 30, 2023; DOI: https://doi.org/10.20408/jti.2023.0036

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Abstract PDF: Blunt intrathoracic tracheal injuries are rare, even among blunt chest trauma patients. An early diagnosis based on a high index of suspicion allows for timely surgical management of potentially fatal airway trauma, thereby improving overall outcomes. Diagnosing these injuries can be difficult due to their nonspecific clinical features and the occasional difficulty in radiologic diagnosis. If a patient exhibits respiratory compromise with difficult ventilation and poor lung expansion, despite the insertion and management of an intercostal drain following high-energy blunt trauma, there should be a heightened suspicion of potential airway trauma. The aim of primary repair is to restore airway integrity and to minimize the loss of pulmonary parenchyma function. This case report discusses the rare clinical presentation of a patient with blunt trauma to the intrathoracic airway, the surgical management thereof, and his overall outcome. Although blunt traumatic injuries of the trachea are extremely rare and often fatal, early surgical intervention can potentially reduce the risk of mortality.; Summary

Bleeding control of an injury to the infrarenal inferior vena cava and right external iliac vein by ipsilateral internal iliac artery and superficial femoral vein ligation after blunt abdominal trauma in Korea: a case report: Hoonsung Park, Maru Kim, Dae Sang Lee, Tae Hwa Hong, Doo-Hun Kim, Hang joo Cho; J Trauma Inj. 2023;36(4):441-446. Published online November 17, 2023; DOI: https://doi.org/10.20408/jti.2023.0019

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Abstract PDF: Inferior vena cava (IVC) injuries, while accounting for fewer than 0.5% of blunt abdominal trauma cases, are among the most difficult to manage. Despite advancements in prehospital care, transportation, operative techniques, and perioperative management, the mortality rate for IVC injuries has remained at 20% to 66% for several decades. Furthermore, 30% to 50% of patients with IVC injuries succumb during the prehospital phase. A 65-year-old male patient, who had been struck in the back by a 500-kg excavator shovel at a construction site, was transported to a regional trauma center. Injuries to the right side of the infrarenal IVC and the right external iliac vein (EIV) were suspected, along with fractures to the right iliac bone and sacrum. The injury to the right side of the infrarenal IVC wall was repaired, and the right internal iliac artery was ligated. However, persistent bleeding around the right EIV was observed, and we were unable to achieve proximal and distal control of the right EIV. Attempts at prolonged manual compression were unsuccessful. To decrease venous return, we ligated the right superficial femoral vein. This reduced the amount of bleeding, enabling us to secure the surgical field. We ultimately controlled the bleeding, and approximately 5 L of blood products were infused intraoperatively. A second-look operation was performed 2 days later, by which time most of the bleeding sites had ceased. Orthopedic surgeons then took over the operation, performing closed reduction and external fixation. Five days later, the patient underwent definitive fixation and was transferred for rehabilitation on postoperative day 22.; Summary

Blunt abdominal trauma resulting in pancreatic injury in a pediatric patient in Australia: a case report: Harmanjit Dev, Colin Kikiros; J Trauma Inj. 2023;36(3):310-314. Published online August 24, 2023; DOI: https://doi.org/10.20408/jti.2023.0013

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Abstract PDF: Pancreatic trauma from a blunt injury is fairly uncommon in the pediatric population. Furthermore, such trauma with associated disruption of the pancreatic duct (PD) is even less prevalent and is associated with high morbidity and mortality. Pancreatic injuries in the pediatric population are often missed and hence require a thorough workup in children presenting with any form of abdominal injury. This case report describes a young boy who presented with abdominal pain and did not initially inform medical staff about any injury. For this reason, his initial provisional diagnosis was appendicitis, but he was later found to have transection of the pancreas with injury to the PD on imaging. The management of such injuries in pediatric patients often poses a challenge due to a lack of pediatric physicians trained to perform interventions such as endoscopic retrograde cholangiopancreatography. Furthermore, such interventions carry a higher risk when performed on children due to the smaller size of their pancreatic ducts. As a result, our patient had to be transferred to an adult center to undergo this procedure. Thus, maintaining a high degree of suspicion, along with a detailed history and examination, is crucial for the early diagnosis and management of pancreatic injuries.; Summary

Successful minimally invasive management using transcatheter arterial embolization in a hemodynamically stable elderly patient with mesenteric vascular injury in a hybrid emergency room system in Korea: a case report: So Ra Ahn, Joo Hyun Lee, Sang Hyun Seo, Chan Yong Park; J Trauma Inj. 2023;36(4):435-440. Published online July 25, 2023; DOI: https://doi.org/10.20408/jti.2023.0018

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4 Citations

Abstract PDF

Mesenteric injury occurs rarely in cases associated with blunt abdominal trauma. Despite its low incidence, mesenteric injury can lead to fatal outcomes such as hypovolemic shock due to hemoperitoneum or sepsis due to intestinal ischemia, or perforation-related peritonitis. For mesenteric injuries, especially those involving massive bleeding, intestinal ischemia, and perforation, the standard treatment is surgery. However, in the case of operative management, it should be borne in mind that there is a possibility of complications and mortality during and after surgery. The usefulness of transcatheter arterial embolization (TAE) is well known in solid organs but is controversial for mesenteric injury. We present a 75-year-old man with mesenteric injury due to blunt abdominal trauma. Initial abdominal computed tomography showed no hemoperitoneum, but a mesenteric contusion and pseudoaneurysm with a diameter of 17 mm were observed near the origin of the superior mesenteric artery. Since there were no findings requiring emergency surgery such as free air or intestinal ischemia, it was decided to perform nonoperative management with TAE using microcoils in hybrid emergency room system. TAE was performed successfully, and there were no complications such as bleeding, bowel ischemia, or delayed bowel perforation. He was discharged on the 23rd day after admission with percutaneous catheter drainage for drainage of mesenteric hematoma. The authors believe that treatment with TAE for highly selected elderly patients with mesenteric injuries has the positive aspect of minimally invasive management, considering the burden of general anesthesia and the various avoidable intraoperative and postoperative complications.

Summary

Citations

Citations to this article as recorded by

Effectiveness of hybrid emergency room system in patients with severe trauma: a systematic review and meta-analysis
Hongrye Kim, Youngmin Kim, Sebeom Jeon, Soon Ki Min, Jaeik Jang, Jayun Cho, Byungchul Yu, Kang Kook Choi, Gil Jae Lee, Junepill Seok, Dong Keon Yon, Wu Seong Kang
International Journal of Surgery.2026; 112(3): 8520. CrossRef
Management of a traumatic superior mesenteric artery injury using superselective angioembolization
Martha Ennis, Jurgienne Umali, David Pace
Journal of Vascular Surgery Cases, Innovations and.2025; 11(2): 101726. CrossRef
Successful Non-Operative Management of Middle Colic Artery Injury Using Transcatheter Arterial Embolization Performed in a Hybrid Emergency Room System
Joo Hyun Lee, So Ra Ahn, Sang Hyun Seo, Chan Yong Park
Journal of Acute Care Surgery.2025; 15(1): 30. CrossRef
Abdomen (A Pandora’s Box): A Delayed Presentation of Blunt Abdominal Injury With a Mesenteric Tear Leading to Gangrenous Bowel
Abishek Prasenaa, Thinagaran K, Reegan Jose , Karthick G
Cureus.2024;[Epub] CrossRef

Ruptured uterus in a 36-week pregnant patient with hemorrhagic shock after blunt trauma in Korea: a case report: Sebeom Jeon, Suyoung Park, Soohyun Oh, Jayun Cho; J Trauma Inj. 2023;36(3):281-285. Published online January 18, 2023; DOI: https://doi.org/10.20408/jti.2022.0070

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Abstract PDF: Traumatic uterine rupture is uncommon but can be fatal and life-threatening for both the mother and infant. In addition to complications caused by trauma itself, such as pelvic fracture, gestational complications such as placental abruption, abortion, premature labor, rupture of membranes, maternal death, and stillbirth can occur. In particular, fetuses have been reported to have a high mortality rate in cases of traumatic uterine rupture. A 36-year-old pregnant female patient fell from the fourth floor and was admitted to our trauma center. We observed large hemoperitoneum, pelvic fractures, and spleen laceration, and the fetus was presumed to be located outside the uterus. The pregnant woman was hemodynamically unstable. Although the fetus was stillborn, angioembolization and surgical treatment were properly performed through collaboration with an interventional radiologist, obstetrician, and trauma surgeons. After two orthopedic operations, the patient was discharged after 34 days. This case report suggests the importance of a multidisciplinary approach in the treatment of pregnant trauma patients.; Summary

Gastric necrosis after gastric artery embolization in a patient with blunt abdominal trauma: a case report: Gil Hwan Kim, Sung Jin Park, Chan Ik Park; J Trauma Inj. 2022;35(4):287-290. Published online December 20, 2022; DOI: https://doi.org/10.20408/jti.2022.0054

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Abstract PDF

Gastric artery bleeding after blunt trauma is rare. In such cases, if vital signs are stable, angiographic embolization may be performed. Although gastric artery embolization is known to be safe due to its anatomical properties, complications may occur. We report a case of gastric necrosis after gastric artery embolization in a patient with blunt abdominal trauma. The 55-year-old male patient was found with gastric arterial bleeding after a traffic accident. His vital signs were stable, and gastric artery embolization was performed. Gastric necrosis was subsequently found, which was treated surgically.

Summary

Citations

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The isolated left gastric artery: A shape-shifting pitfall for neuroangiographers
Philippe Gailloud
Interventional Neuroradiology.2025;[Epub] CrossRef

Original Article

National utilization of rib fracture fixation in the geriatric population in the United States: Jennifer M. Brewer, Leah Aakjar, Kelsey Sullivan, Vijay Jayaraman, Manuel Moutinho, Elan Jeremitsky, Andrew R. Doben; J Trauma Inj. 2022;35(3):173-180. Published online May 31, 2022; DOI: https://doi.org/10.20408/jti.2021.0076

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5 Citations

Abstract PDF

Purpose
The use of surgical stabilization of rib fractures (SSRF) has steadily increased over the past decade. Recent literature suggests that a larger population may benefit from SSRF, and that the geriatric population—as the highest-risk population—may receive the greatest improvement from these interventions. We sought to determine the overall utilization of SSRF in the United States.
Methods
The National Trauma Database was analyzed between 2016 and 2017. The inclusion criteria were all patients ≥65 years old with rib fractures. We further stratified these patients according to age (65–79 vs. ≥80 years old), the presence of coding for flail chest, three or more rib fractures, and intervention (surgical vs. nonoperative management). The main outcomes were surgical interventions, mortality, pneumonia, length of stay, intensive care unit length of stay, ventilator use, and tracheostomy.
Results
Overall, 93,638 patients were identified. SSRF was performed in 992 patients. Patients who underwent SSRF had improved mortality in the 65 to 79 age group, regardless of the number of ribs fractured. We identified 92,637 patients in the age group of 65 to 79 years old who did not undergo SSRF. This represents an additional 20,000 patients annually who may benefit from SSRF.
Conclusions
By conservative standards and the well-established Eastern Association for the Surgery of Trauma clinical practice guidelines, SSRF is underutilized. Our data suggest that SSRF may be very beneficial for the geriatric population, specifically those aged 65 to 79 years with any rib fractures. We hypothesize that roughly 20,000 additional cases will meet the inclusion criteria for SSRF each year. It is therefore imperative that we train acute care surgeons in this skill set.

Summary

Citations

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Surgical Stabilization of Rib Fractures in Geriatric Trauma Patients: A National Trauma Data Bank Review
Jared Plumb, Gena V. Topper, Jacob Metheny, Patrick Morris, T. Hess, Krystal Hunter, Malia Voytik, Connor Magura, Asanthi Ratnasekera, Tanya Egodage
Journal of the American Geriatrics Society.2026; 74(3): 738. CrossRef
Surgical Stabilization of Rib Fractures: Current Evidence and Considerations for Posterior Rib Fractures
I Komang Renteg Sumaarsana, I Gusti Agung Made Adnyana Putra, Ni Made Aprilia Sari
Annals of Thoracic and Cardiovascular Surgery.2026; 32(1): n/a. CrossRef
When to pursue acute rib fracture fixation
Alexandra C. Ferre, Adrian Coleoglou Centeno, Daniel G. Vanderploeg, Frederic M. Pieracci
Current Opinion in Critical Care.2025; 31(3): 270. CrossRef
Early surgical stabilization of multiple rib fractures and flail chest is associated with better outcomes compared with nonoperative management
Junsik Kwon, Bishoy Zakhary, Bruno C. Coimbra, Babak Sarani, Raul Coimbra
Journal of Trauma and Acute Care Surgery.2025; 99(6): 859. CrossRef
Incidence of adult rib fracture injuries and changing hospitalization practice patterns: a 10-year analysis
Sergio M. Navarro, Rafat H. Solaiman, Jilun Zhang, Ilitch Diaz-Gutierrez, Christopher Tignanelli, James V. Harmon
European Journal of Trauma and Emergency Surgery.2024; 50(4): 1719. CrossRef

Case Reports

Complete Transection of the Cystic Duct and Artery after Blunt Trauma: A Case Report: Sung Hoon Cho, Kyoung Hoon Lim; J Trauma Inj. 2021;34(4):294-298. Published online December 16, 2021; DOI: https://doi.org/10.20408/jti.2021.0097

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Abstract PDF

Extrahepatic biliary tract and gallbladder injuries following blunt abdominal trauma are uncommon. Traumatic cystic duct transection is even rarer, which has frequently caused missed diagnosis and delayed treatment. An 18-year-old female patient with no past medical history was transferred to the Trauma Center of Kyungpook National University Hospital after falling from a height of approximately 20 meters. She became hemodynamically stable after initial resuscitation, and initial contrast-enhanced abdominal computed tomography (CT) showed right kidney traumatic infarction and multiple intrahepatic contusions with minimal fluid collection but no extravasation of the contrast. She was admitted to the intensive care unit. On the second day of hospitalization, her abdomen became distended, with follow-up CT showing a large collection of intra-abdominal fluid. Laparoscopic exploration was then performed, which revealed devascularization of the gallbladder with complete transection of the cystic duct and artery. Laparoscopic cholecystectomy was performed, as well as primary closure of the cystic duct orifice on the common bile duct using a 4-0 Prolene suture. After surgery, no clinical evidence of biliary leakage or common bile duct stricture was observed.

Summary

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Isolated Cystic Duct Injury Caused by a Gunshot Wound: A Case Report of an Extremely Rare Finding
Andrés David De León Murillo, Pedro Antonio Plaza Ricardo, Indira Tatiana Contreras Vanegas, Miguel Angel Fuentes Iglesias, Sergio A Tavera, Tatiana Paola Pérez García, Alejandro Alfonso Bedoya Rinaldi
Cureus.2025;[Epub] CrossRef
A Rare Complication of Percutaneous Transhepatic Gallbladder Drainage
Yang-Yuan Chen, Chih-Hsuan Chen, Yung-Fang Chen
Gastroenterology.2022; 163(5): e29. CrossRef

Extra-Pericardial Tamponade due to Internal Thoracic Artery Rupture after Blunt Trauma: A Case Report: Dongsub Noh, Sung Wook Chang, Dae Sung Ma; J Trauma Inj. 2021;34(3):183-186. Published online September 30, 2021; DOI: https://doi.org/10.20408/jti.2021.0045

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Cardiac tamponade is an acute life-threatening condition that predominantly involves the intra-pericardial space; however, an expanding mediastinal hematoma can also sometimes cause cardiac tamponade. Here we describe the case of a 45-year-old male driver in whom a traffic accident resulted in rupture of the left internal thoracic artery (ITA), extra-pericardial hematoma, and sternal fracture. After resuscitation, he was scheduled to undergo angio-embolization to repair the ruptured left ITA, but he suddenly developed cardiac tamponade that required a decompressive sternotomy. Nevertheless, the patient had an uncomplicated recovery, and this case suggests that extra-pericardial cardiac tamponade should be considered as a possible consequence of retro-sternal hematoma due to traumatic ITA rupture.

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QJM: An International Journal of Medicine.2026;[Epub] CrossRef
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