Journal of Trauma and Injury

Diagnostic pitfalls of computed tomography angiography in high-energy knee trauma: two case reports on complete popliteal artery transection despite preserved distal flow: Shinseok Kim, Joosuk Ahn; J Trauma Inj. 2026;39(3):291-296. Published online September 17, 2026; DOI: https://doi.org/10.20408/jti.2025.0199

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Abstract PDF: This report describes two rare cases of complete popliteal artery transection in young, previously healthy men following high-energy trauma. In both cases, computed tomography (CT) angiography demonstrated a segmental arterial defect with preserved distal flow and no contrast extravasation, resulting in a delayed or uncertain diagnosis. These cases underscore the importance of incorporating the mechanism of injury into clinical decision-making. Both patients exhibited neurologic deficits in the affected limbs. Physical examination revealed signs of ischemia and sensorimotor dysfunction. Despite discordant CT findings, surgical exploration confirmed complete arterial transection in both cases, necessitating vascular reconstruction. In cases of high-energy knee trauma, surgical exploration should be considered when clinical findings suggest neurovascular compromise, even if CT angiography demonstrates preserved distal flow.; Summary

Traumatic carotid artery dissection without head or neck trauma: a case report following thoracoabdominal crush injury: Shin-Ah Son; J Trauma Inj. 2026;39(3):297-301. Published online August 19, 2026; DOI: https://doi.org/10.20408/jti.2025.0207

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Abstract PDF: A previously healthy 41-year-old woman was admitted after being crushed beneath a forklift from the chest to the lower extremities, presenting with traumatic asphyxia. Initial evaluation revealed no apparent trauma to the head or neck, but multiple fractures from the chest to the lower extremities were diagnosed. The patient underwent emergent thoracoabdominal surgery with subsequent clinical improvement. However, 4 days after the accident, anisocoria developed, and neuroimaging confirmed ischemic stroke due to traumatic carotid artery dissection. Anticoagulation and lipid-lowering therapy were initiated, and the patient successfully underwent the remaining orthopedic procedures without hemorrhagic complications. This report emphasizes that traumatic carotid artery dissection may occur even in the absence of concomitant cervical or cranial injuries, highlighting the importance of considering vascular injury in patients with severe trauma regardless of the mechanism of injury.; Summary

Supercharging of the axillary nerve with a nerve innervating the triceps in a partial traumatic brachial plexus injury of a 5-year-old child in India: a case report: Sanjay Kumar Giri, Ahana Bandyopadhyay, Santanu Suba; Received August 21, 2025 Accepted November 27, 2025 Published online August 19, 2026; DOI: https://doi.org/10.20408/jti.2025.0203 [Epub ahead of print]

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Abstract PDF: A 5-year-old girl presented with an inability to abduct her left shoulder and flex her left elbow following a fall 1.5 months earlier. Electrodiagnostic studies were suggestive of a partial upper trunk brachial plexus injury. The child was advised to attend monthly follow-up visits with regular physiotherapy and nerve stimulation. At 3 months after injury, elbow flexion had recovered completely, and shoulder abduction had improved to 30°. After an additional month of observation without further clinical improvement in shoulder abduction, a nerve-to-triceps transfer to the axillary nerve was planned in the fifth month. Intraoperatively, the posterior division of the axillary nerve was found to be excitable. To preserve nerve continuity, an end-to-side supercharging procedure was performed using the nerve to the medial head of the triceps to augment the axillary nerve. The postoperative period was uneventful, and physiotherapy was resumed 3 weeks after surgery. Within 7 months of surgery, the patient demonstrated full shoulder abduction. Restoration of shoulder function is a primary goal in the management of brachial plexus injuries. Nerve transfers offer substantial potential for improved functional recovery. In this case, lateral neurorrhaphy of the nerve to the medial head of the triceps to the axillary nerve provided additional motor input, facilitating earlier deltoid recovery. Early surgical intervention in selected cases may contribute to faster and more effective recovery, particularly in the pediatric population.; Summary

Neuroleptic malignant syndrome in a cervical spinal injury patient: a case report: Binayak Deb, Yudhyavir Singh, Shuchi Smita, Sreehari N; J Trauma Inj. 2026;39(2):191-194. Published online June 24, 2026; DOI: https://doi.org/10.20408/jti.2025.0159

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Abstract PDF: Neuroleptic malignant syndrome (NMS) is a rare, idiosyncratic, and potentially fatal complication associated with the abrupt withdrawal of dopaminergic agents or the use of antidopaminergic medications that affect the hypothalamus and basal ganglia. Its hallmark features include severe hyperthermia, altered consciousness, skeletal muscle rigidity, and autonomic instability. We present the case of a young patient with a cervical spine injury who was admitted to the trauma intensive care unit (ICU). The patient developed a persistent high-grade fever that did not respond to standard interventions, which was ultimately attributed to NMS resulting from the administration of neuroleptic medications. Because of a high degree of clinical suspicion and the implementation of prompt therapeutic measures, the patient achieved a favorable clinical outcome. Early diagnosis and timely intervention are crucial in NMS due to its rapid clinical progression, particularly as the use of dopaminergic antagonists becomes more prevalent in ICU settings. This case highlights the diagnostic challenges of managing NMS alongside spinal trauma in the ICU, as NMS often mimics common postoperative and ICU-related complications, necessitating heightened clinical vigilance.; Summary

Penile artery traumatic occlusion causing arteriogenic erectile dysfunction: a case report: Francesco Michele Ronza, Teresa Letizia Di Gennaro, Francesco Palmieri, Stefania Tamburrini; Received April 11, 2025 Accepted July 4, 2025 Published online April 22, 2026; DOI: https://doi.org/10.20408/jti.2025.0085 [Epub ahead of print]

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Abstract PDF Supplementary Material: We present a case of traumatic penile artery occlusion resulting in arteriogenic erectile dysfunction. A 34-year-old man was referred to the emergency department following a motorbike collision that caused pelvic trauma. Contrast-enhanced multidetector computed tomography revealed a complex pelvic fracture pattern, including pubic diastasis, fracture of the left sacral ala, and avulsion of the left ischiatic spine, along with penile artery occlusion and absence of homolateral cavernosal corpora blushes. Contrast-enhanced multidetector computed tomography is a comprehensive and precise imaging modality for evaluating pelvic trauma. Assessment of the penile artery and internal pudendal artery network is crucial in pelvic trauma cases to promptly identify arterial occlusion and facilitate timely evaluation and management of erectile dysfunction.; Summary

Diagnosis of a peritoneal injury during acetabular fracture surgery using the Stoppa approach: a case report: Reza Zandi, Shahin Talebi, Mohammad Rahnama, Milad Saeidi, Shirin Sheibani; Received May 7, 2025 Accepted August 10, 2025 Published online April 2, 2026; DOI: https://doi.org/10.20408/jti.2025.0103 [Epub ahead of print]

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Abstract PDF: As the global population ages, acetabular fractures are increasingly diagnosed in older adults. These injuries, often caused by low-energy trauma, present treatment challenges due to reduced bone quality and the presence of comorbidities. Surgical fixation is frequently required to restore mobility and prevent long-term disability. In some cases, however, associated abdominopelvic injuries may remain occult until discovered intraoperatively. We report the case of a 67-year-old woman who sustained an acetabular fracture after a fall from height. During internal fixation using the modified Stoppa approach, an undetected peritoneal rupture was identified. This case underscores the importance of careful preoperative evaluation and preparedness for intraoperative collaboration with abdominal surgery teams, particularly when subtle abdominal signs are present.; Summary

Traumatic posterior dislocation of the sternoclavicular joint in a 12-year-old boy: a case report: Amani Azizalrahman, Altaf Ahmad Bhat, Abdulaziz Khalid Alareefy, Abdulaziz Abdullah Oalsuhaiban; Received March 10, 2025 Accepted May 22, 2025 Published online April 2, 2026; DOI: https://doi.org/10.20408/jti.2025.0057 [Epub ahead of print]

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Abstract PDF: Sternoclavicular joint (SCJ) dislocation is a rare but serious orthopedic injury, representing fewer than 1% of all fractures or dislocations. Posterior dislocations are particularly concerning due to the SCJ’s proximity to vital structures such as the trachea, esophagus, subclavian vessels, and brachial plexus. Clinical suspicion should be heightened when a patient presents with a compression-type injury to the shoulder girdle and pain around the SCJ. We report the case of a 12-year-old boy who presented to the emergency department after being punched in the right shoulder by another child, resulting in severe pain and an inability to move his right shoulder. Clinical assessment raised suspicion for a posterior SCJ dislocation, which was confirmed by computed tomography scan. The rarity of this condition in pediatric patients, coupled with the potential for severe complications, underscores the significance of this case for clinical recognition and management.; Summary

An unusual open pneumothorax due to high-voltage electrical burn injury: a case report: Norberto Navarrete, Sandra J. Bernal, Laura S. Nasiff, Federico Fernandez; Received May 29, 2025 Accepted August 11, 2025 Published online April 1, 2026; DOI: https://doi.org/10.20408/jti.2025.0122 [Epub ahead of print]

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Abstract PDF: Open intrathoracic visceral injuries are rare in electrical burns. We report the case of a 65-year-old man who sustained a high-voltage electrical burn through direct cable exposure. He arrived at the burn intensive care unit with respiratory distress secondary to an open wound on the right side of the chest wall measuring approximately 4×2 cm, with a calculated total body surface area of 2%. An immediate thoracostomy tube was placed to treat the open pneumothorax. Pneumopericardium, pneumomediastinum, and pleural infection developed later as delayed complications despite initial stabilization. After 42 days of hospitalization, the patient was discharged. This case highlights the rare occurrence of thoracic complications following electrical injury and underscores the importance of multidisciplinary, phased therapy in the management of severe electrical damage.; Summary

Complete avulsion of the proximal hamstring tendon in a young gymnast: a case report: Shreya Jaiwant Gudigar, Pavan Kumar A, P. K. Karthik Yelamarthy, S. T. Ramanuja Chari, Raghava Dutt Mulukutla, Preeti Shah; Received May 27, 2025 Accepted August 19, 2025 Published online April 1, 2026; DOI: https://doi.org/10.20408/jti.2025.0121 [Epub ahead of print]

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Abstract PDF: Proximal hamstring complex tears are uncommon injuries in gymnastics. This case report describes a rare instance of a 17-year-old female gymnast who sustained a complete avulsion of the proximal hamstring complex during exercise. The injury was diagnosed clinically and later confirmed by magnetic resonance imaging as a proximal hamstring tear, prompting surgical repair with suture anchors. The patient underwent a structured rehabilitation program with progressive milestones in weight-bearing, mobility, and strength training. By postoperative 26 weeks, she had regained functional strength and returned to competitive activity. This case highlights the importance of early diagnosis, timely surgical intervention, and a carefully managed rehabilitation protocol in achieving successful outcomes for young gymnasts. It also underscores the need for greater awareness and documentation of proximal hamstring complex tears in gymnastics, where such cases remain underreported. This report demonstrates the potential for full recovery and return to sport with appropriate treatment and rehabilitation, providing valuable insight into the management of this rare injury.; Summary

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

The voice of injury: a case report of isolated trauma to the larynx: Najeebuddin Mohammed, Ashima Sharma, Alekhya Machani, Sujata Patnaik; J Trauma Inj. 2026;39(1):85-89. Published online March 31, 2026; DOI: https://doi.org/10.20408/jti.2025.0065

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Abstract PDF: Although uncommon, laryngotracheal injuries carry a significant risk of mortality. This rare case of isolated laryngeal injury underscores the importance of recognizing the various potential presentations of such injuries and highlights the evidence-based management strategies that every emergency physician should consider when treating potential airway trauma. A 45-year-old male motorcyclist was involved in a road traffic accident during the night and presented to the emergency department the following morning. The patient complained of breathlessness, neck pain, hoarseness of voice, and noisy breathing. Examination revealed stridor, swelling in zones 1 and 2 of the neck, tenderness over the thyroid, and subcutaneous emphysema over the neck and anterior chest. A definitive airway was secured, and computed tomography imaging revealed a fracture of the thyroid cartilage. The patient was managed conservatively, extubated after 1 week, and discharged after 2 days of observation. Classification of the type of injury and the use of an algorithmic approach, involving consensus among the emergency department, trauma surgeons, and the critical care team, can help streamline and standardize management of these cases. Furthermore, a thorough understanding of the dos and don’ts in securing the airway in patients with laryngotracheal injuries increases the robustness of the approach to managing this patient population.; Summary

Contralateral pulmonary resection with drug-induced thrombocytopenia after previous lobectomy in chest trauma: a case report: Do Wan Kim, Kyo Seon Lee, Sang Yun Song, In-Seok Jeong; J Trauma Inj. 2026;39(2):186-190. Published online March 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0157

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Abstract PDF: Secondary pulmonary resection remains challenging because of the risk of serious complications. A second thoracic surgical procedure in elective settings should prioritize the patient’s recovery potential and functional status. In thoracic oncology, clinical outcomes can be acceptable in selected patients. However, when vital signs are unstable due to traumatic lung injury, selection is not the primary consideration and emergency surgery is required. Thrombocytopenia is a condition in which a patient’s platelet count is abnormally low, diagnosed by complete blood count. In humans, the normal platelet count generally ranges from 150,000 to 450,000 platelets/μL of blood. In posttraumatic patients, thrombocytopenia is often difficult to manage because its causes are diverse. To our knowledge, survival after secondary contralateral lung resection in a patient with thrombocytopenia who previously underwent lobectomy for lung cancer is extremely rare.; Summary

Pneumatosis cystoides intestinalis misdiagnosed as pneumoperitoneum due to colon perforation in a patient with blunt trauma injuries: a case report: So Ra Ahn, Joo Hyun Lee, Chan Yong Park; J Trauma Inj. 2026;39(2):182-185. Published online March 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0155

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Abstract PDF: A laparotomy is usually performed when pneumoperitoneum is identified on abdominal computed tomography (CT) in patients with trauma-related injuries. However, in rare cases, pneumatosis cystoides intestinalis (PCI) may be misinterpreted as free air due to bowel perforation. PCI typically follows a benign course and can be managed with physical examinations and imaging studies. In this case, however, the patient was comatose from a severe traumatic brain injury, rendering the physical examination unreliable. Abdominal CT revealed multiple extraluminal air foci in the retroperitoneal space surrounding the ascending colon, consistent with pneumoperitoneum. No evidence of intraoperative peritonitis was found. Nevertheless, because bowel perforation could not be definitively excluded, a right hemicolectomy was performed, and histopathological examination confirmed PCI.; Summary

An obstinate intracranial bullet: a case report: Simon Tomala, Bernardo Bollen Pinto; Received June 20, 2025 Accepted July 30, 2025 Published online March 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0139 [Epub ahead of print]

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Abstract PDF: We report the case of a 52-year-old man with a history of psychiatric illness who sustained an intracranial gunshot wound. Within 20 hours, the bullet spontaneously migrated from the right to the left frontal lobe, as confirmed by two computed tomography scans, which led to a failed extraction in the operating theater. A decision was ultimately made not to reoperate. The patient is therefore currently living with a retained intracranial bullet and a decompensated psychiatric state. This case emphasizes the importance of perioperative imaging to adapt surgical planning and highlights the critical impact of bullet migration on prognosis and management.; Summary

Iatrogenic cardiac injury following prehospital needle decompression: a case report: Khalid Ahmed, Rabab Abdelrahman, Murad Alahmad, Ammara Bint I Bilal, Al-jouhara Albaloshi, Mohamed H. Ahmed, Husham Abdelrahman, Hafeez Ulla Lone, Sankar Balasubramanian, Ayman El-Menyar, Sandro Rizoli, Hassan Al-Thani, Talat Chughtai; Received June 17, 2025 Accepted July 15, 2025 Published online March 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0136 [Epub ahead of print]

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Abstract PDF: Tension pneumothorax is a life-threatening condition that necessitates prompt intervention, typically via prehospital needle thoracostomy. However, this procedure carries risks such as cardiac injury. We report the case of a 20-year-old man involved in an all-terrain vehicle accident who presented with a low Glasgow Coma Scale (GCS) score, respiratory distress, and hypotension. Prehospital intubation and left-sided needle thoracostomy were performed for suspected pneumothorax and depressed GCS score. Pulsatile bleeding from the catheter was noted. Imaging in the trauma bay revealed catheter penetration into the left ventricle. Pan computed tomography confirmed the cardiac injury and identified a severe traumatic brain injury. The patient underwent surgical repair of the heart via median sternotomy. He recovered well and was subsequently transferred for rehabilitation. This case highlights the risks associated with emergent, blind needle thoracostomy in the prehospital setting. Improved outcomes depend on refined technique, accurate anatomical identification, and appropriate needle selection.; Summary

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