Journal of Trauma and Injury

Case Reports

Facial trauma and reconstructive surgery: insights from a case series of severe maxillofacial injuries: Harendra Kumar, Abdul Hakeem, Abdul Vakil Khan, Rachith Sridhar, Deepak Kumar, Majid Anwer; Received April 7, 2025 Accepted September 7, 2025 Published online February 4, 2026; DOI: https://doi.org/10.20408/jti.2025.0080 [Epub ahead of print]

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Abstract PDF: Facial trauma is a complex and important contributor to trauma-related morbidity, often requiring multidisciplinary management due to intricate anatomy and the dual need for functional and aesthetic restoration. This case series describes a spectrum of maxillofacial injuries treated by trauma surgeons, including soft tissue degloving, zygomaticomaxillary complex fractures, mandibular fractures, and airway compromise. All patients were managed in accordance with Advanced Trauma Life Support (ATLS) principles. Surgical interventions included layered wound closure, open reduction and internal fixation, and airway management through endotracheal intubation, cricothyroidotomy, or tracheostomy. The series underscores the critical decision-making required in airway management, the surgical expertise necessary for fracture stabilization, and the importance of early reconstruction in optimizing outcomes. It further emphasizes the role of trauma surgeons in delivering comprehensive care and highlights the value of preventive strategies such as helmet use and road safety enforcement. These cases contribute to the growing evidence that timely, coordinated surgical intervention supports optimal recovery in patients with facial trauma.; Summary

Iatrogenic vascular injury during retrograde intramedullary nailing of a distal femur fracture: a case report: Jeong Seok Choi, JunHyeok Kwon, Yun Ki Ryu, Wonseok Choi, Seonghyun Kang, Jong-Keon Oh, Jae-Woo Cho; J Trauma Inj. 2025;38(4):399-403. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0238

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Abstract PDF: We report a case of iatrogenic injury to the lateral circumflex femoral artery following distal femoral nailing in a 72-year-old patient. Postoperatively, progressive thigh swelling developed, but initial contrast-enhanced computed tomography (CT) showed no evidence of vascular injury. The arterial injury was subsequently identified on a follow-up contrast-enhanced CT scan and was successfully treated with angiographic microcoil embolization. This case underscores the critical importance of meticulous awareness of the trajectories of the lateral circumflex and deep femoral arteries during proximal interlocking screw insertion. It also highlights that early postoperative imaging can fail to detect such vascular complications. Therefore, a high index of clinical suspicion is paramount, and repeated imaging should be strongly considered if clinical signs, such as progressive swelling, persist despite initial negative findings.; Summary

Subclavian artery injury following clavicle fracture successfully treated with an urgent conversion to endovascular method: a case report: Jiwon Kim, Jonghwan Moon; J Trauma Inj. 2025;38(4):394-398. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0168

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Abstract PDF: Subclavian artery injury is a rare complication of clavicular fracture. This condition most often results from penetrating trauma but may also occur after blunt injury, when bone fragments cause rupture, pseudoaneurysm, dissection, or arterial thrombosis. Subclavian artery injury associated with clavicular fracture occurs in less than 1% of cases and may lead to life-threatening hemorrhage or limb ischemia. We report a case of subclavian artery injury secondary to a clavicular fracture that was successfully managed with endovascular intervention. A 48-year-old man presented to the emergency department after a downhill bicycle crash with a right midshaft clavicle fracture and was scheduled for open reduction and internal fixation (ORIF) 11 days later. Intraoperatively, rupture of a subclavian artery pseudoaneurysm caused massive hemorrhage. Surgical dissection was complicated by severe perivascular inflammation and a high risk of iatrogenic subclavian vein injury. Immediate conversion to an endovascular approach allowed successful hemostasis through femoral artery access and covered stent deployment, after which ORIF was completed. The patient recovered without neurovascular complications and was discharged on postoperative day 5. At 12 weeks, he achieved full shoulder range of motion, and 2-year follow-up angiography showed no stent-related complications. This case underscores the effectiveness of emergent endovascular intervention for ruptured traumatic subclavian pseudoaneurysm when inflammation and risk of iatrogenic injury preclude safe open dissection. A hybrid or rescue endovascular strategy should be considered for similar complex trauma cases.; Summary

Catastrophic complications from inadequate early soft tissue surveillance in a closed pilon fracture: a case report: Jeong-Hyun Koh, Sumin Lim, Hyung Keun Song, Wan-Sun Choi, Won-Tae Cho, Seungyeob Sakong; J Trauma Inj. 2025;38(4):404-411. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0158

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Abstract PDF: 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.; Summary

Foreign body retained in the sole of the foot for over 30 years: a case report: Min Gyu Kyung; Received May 12, 2025 Accepted July 18, 2025 Published online December 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0107 [Epub ahead of print]

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Abstract PDF: A 41-year-old man presented with discomfort in the medial arch of his foot, which worsened with weight-bearing. The condition had initially been misdiagnosed as plantar fasciitis, and he had received conservative treatment without imaging, with no relief of symptoms. Plain radiography and computed tomography later revealed a 2.5-cm radiopaque, needle-like foreign body in the superficial midfoot. Further history-taking revealed that the patient had stepped on a sewing needle during childhood, approximately 35 years earlier. The foreign body was surgically removed through an extended incision, as it was encased in granulomatous tissue and was not easily accessible via a minimally invasive approach. Histopathological examination confirmed a fibrous reaction with granuloma formation surrounding the retained metallic object. The patient remained asymptomatic postoperatively and returned to normal activity. To the author’s knowledge, this is the first reported case of a sewing needle retained in the foot for over 30 years without an allergic reaction or infection. Although many foreign bodies are detected shortly after injury, this case highlights the importance of thorough history-taking and appropriate imaging, especially when symptoms mimic common conditions such as plantar fasciitis. Additionally, in long-standing cases, complete encapsulation by reactive tissue may necessitate more extensive surgical exposure for successful removal.; Summary

Subclavian artery pseudoaneurysm treated with surgery following endovascular balloon occlusion: a case report: Jaeik Jang, Jayun Cho; J Trauma Inj. 2025;38(4):389-393. Published online December 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0078

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Abstract PDF: Subclavian vessel injury concomitant with a closed clavicle fracture is rare, and challenges associated with exposure often make proximal control difficult. This paper presents the case of a 26-year-old man who presented to the emergency department after a fall from the sixth floor with multiple injuries, including closed clavicle fractures and a subclavian artery pseudoaneurysm. Proximal control was achieved with endovascular balloon occlusion rather than by performing cervical extension of median sternotomy. Subsequently, exposure was obtained through a subclavian incision, and the injury was treated with a bypass graft.; Summary

Isolated orbital roof fracture with concurrent orbital compartment syndrome: a case report: Khalifa Al Alawi, Sondus Al Jadeedi, Sultan Al Shaqsi, Meera Sahib, Taimoor Al Balushi; Received March 24, 2025 Accepted August 17, 2025 Published online December 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0070 [Epub ahead of print]

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Abstract PDF: 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.; Summary

Self-inflicted rectal injury triggering acute myocardial infarction: a case report: Muge Gulen, Mehmet Gorur, Salim Satar, Selen Acehan, Ozge Ozcan Abacioglu, Adnan Kuvvetli; Received June 18, 2025 Accepted July 5, 2025 Published online November 20, 2025; DOI: https://doi.org/10.20408/jti.2025.0138 [Epub ahead of print]

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Abstract PDF: A 47-year-old male patient who had self-inserted a rectal foreign body for anal autoerotic purposes was admitted to the emergency department. Thirty minutes after admission, he developed chest pain and profuse sweating. Electrocardiography revealed an acute inferior myocardial infarction. Initially, the patient underwent coronary angiography, and percutaneous transluminal angioplasty was performed for a 100% occlusion of the right coronary artery. Subsequently, under general anesthesia, the foreign body was removed via rectal examination in the lithotomy position. This rare clinical scenario, which has not been previously reported in the literature, highlights the potential for psychological trauma and local rectal injury to act as triggers for myocardial infarction. Respecting patient confidentiality, maintaining a nonjudgmental approach, and implementing a multidisciplinary strategy are critically important for the effective management of such uncommon cases.; Summary

Bridging the gap: a successful interhospital transfer of a bleeding pelvic fracture patient using REBOA and the “doctor car” system: a case report: Hanbyol Song, Gil Jae Lee, Byungchul Yu, Seung Hwan Lee, Min A Lee, Myung Jin Jang, Jeong Ho Kim, Kang Kook Choi; Received March 11, 2025 Accepted May 22, 2025 Published online November 20, 2025; DOI: https://doi.org/10.20408/jti.2025.0059 [Epub ahead of print]

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Abstract PDF: Severe traumatic injuries, particularly unstable pelvic fractures, frequently result in life-threatening hemorrhagic shock, necessitating urgent transfer to specialized trauma centers. However, interhospital transport of hemodynamically unstable patients poses a significant risk of clinical deterioration. Resuscitative endovascular balloon occlusion of the aorta (REBOA) offers effective temporary hemodynamic stabilization before definitive care. Here, we describe the successful use of zone III REBOA by a surgeon-staffed emergency medical service (“doctor car”) to rapidly stabilize and safely transfer a 62-year-old man with a severe bleeding pelvic fracture. Upon arrival at the trauma center, the patient underwent immediate definitive treatments, including preperitoneal pelvic packing and transarterial embolization. This case highlights the potential for integrating REBOA with physician-staffed emergency transport systems as a strategy to bridge critical gaps in regional trauma care networks and improve patient outcomes.; Summary

Bowel maneuvers for achieving colonic continuity after extensive colon resection due to abdominopelvic trauma: two case reports: Barak Raguan, Fahim Awaad, Ephraim Katz, Dean Lutrin, Yoram Klein, Ilan Kent; Received March 6, 2025 Accepted May 15, 2025 Published online November 20, 2025; DOI: https://doi.org/10.20408/jti.2025.0052 [Epub ahead of print]

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Abstract PDF: Restoring large bowel continuity after extensive resection due to abdominopelvic trauma may be challenging because of the limited length of the remaining bowel. Achieving a tension-free anastomosis can be particularly difficult when attempting this within the pelvis due to a short rectal stump. Two maneuvers that can aid in these situations are the retroileal pull-through approach and the Deloyers procedure. We describe two cases in which each maneuver was utilized to facilitate colostomy closure following extensive large bowel resection resulting from abdominopelvic trauma. Both maneuvers proved feasible, successfully allowing bowel continuity to be restored with tension-free anastomoses. Protective loop ileostomies were performed in both cases. Postoperative contrast enema studies did not show evidence of anastomotic leaks. After ileostomy closure, both patients regained bowel function with good bowel control. Bowel manipulation maneuvers following abdominal trauma are therefore feasible and facilitate tension-free anastomosis after extensive colonic and rectal resections. Trauma and colorectal surgeons managing abdominal trauma patients requiring ostomy closure should become familiar with these techniques.; Summary

An exsanguinating arterial-vesical injury after a gunshot wound to the lower extremity: a case report: Brendan P. Stewart, Herbert Downton Ramos, Andrew R. Doben, Stephanie C. Montgomery; Received February 28, 2025 Accepted May 2, 2025 Published online November 20, 2025; DOI: https://doi.org/10.20408/jti.2025.0046 [Epub ahead of print]

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Abstract PDF: Arterial-vesical injuries are rare entities, often presenting with bladder distension, bright red hematuria, and clot retention. The few cases reported in the literature typically occur following traumatic injuries to the groin or pelvis. We present a case of an arterial and vesical injury with decompression through the bladder. Our patient was a 21-year-old man who presented to a level I trauma center as a high-level activation trauma case following a single gunshot wound to the left lateral thigh. Upon arrival, the patient's systolic blood pressure was 80/50 mmHg. A pelvic x-ray revealed ballistic fragments in the pelvis. Physical examination showed a 1+ palpable left dorsalis pedis pulse. He underwent a formal trauma laparotomy, which did not identify any acute injuries. Concurrently, his Foley catheter exhibited bloody output with bladder distension. Following continuous bladder irrigation, he had profuse sanguineous output. Angiography revealed a complete disruption of the profunda femoris artery. An open exploration of the femoral canal was performed to achieve proximal control of the common femoral artery. We identified a 3-cm longitudinal injury to the profunda femoris artery and an obliterated femoral vein, both of which were ligated, resulting in decreased bladder exsanguination and hemodynamic stabilization. Consistent with the limited published cases of arterial-vesical fistula, our patient presented after a traumatic groin injury. Maintaining a high index of suspicion for communication between the thigh and extraperitoneal space due to projectile trajectory remains crucial to successfully managing these challenging injuries.; Summary

Damage control thoracotomy with chest packing for hemorrhage control in massive hemothorax and shock: a case report: Shivinder Singh, Jitendra Kumar Singh, Shalendra Singh, Aishwainee VG, Umesh Kumar, Venkat Narayanan; Received March 10, 2025 Accepted May 15, 2025 Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0066 [Epub ahead of print]

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Abstract PDF: Severe hemorrhagic shock is a leading cause of death among potentially salvageable casualties. We report the case of a 24-year-old man who sustained a gunshot wound to the right hemithorax and presented with class IV hemorrhagic shock. He underwent resuscitative damage control via a right posterolateral thoracotomy. Intraoperatively, the bleeding source was identified as a lacerated posterior intercostal artery at the level of the 11th dorsal vertebra. Because access to the bleeding site remained limited even after extending the incision, right thoracic packing was performed to control the hemorrhage. On reevaluation 48 hours later, no active bleeding was observed.; Summary

Penetrating orbital floor injury by an undetected foreign body: a case report: Simon Chummar, Yamini Ghatikar, K Thoi Thoi Singha, Divya Ann Mathews; Received January 31, 2025 Accepted April 7, 2025 Published online September 3, 2025; DOI: https://doi.org/10.20408/jti.2025.0025 [Epub ahead of print]

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Abstract PDF: Orbital trauma can result in significant complications, particularly when accompanied by foreign body entrapment. Wooden foreign bodies are rare but carry a high risk of infection and chronic inflammation. In these cases, immediate surgical intervention is critical for restoring orbital anatomy and preventing complications. A 16-year-old male patient presented with a 2-month history of persistent pus discharge from his right cheek following facial trauma sustained from a fall. Initial management involved drainage of the abscess; however, the condition persisted. On examination, the patient exhibited infraorbital nerve paresthesia and an orbital floor fracture, and his history was notable for prior foreign body retrieval involving wooden fragments. Computed tomography revealed retained foreign bodies and discontinuity of the orbital floor. Surgical management included foreign body retrieval, the Caldwell-Luc procedure, and orbital floor reconstruction with mesh and platelet-rich fibrin placement. The patient’s symptoms progressively improved over 6 months, with a reduction in paresthesia and no ocular or intracranial complications despite the delayed presentation. This case highlights the challenges of diagnosing and managing penetrating wooden foreign bodies in orbital trauma. It underscores the importance of prompt surgical intervention and interdisciplinary care to prevent potentially critical complications.; Summary

Management of posttraumatic refractory paroxysmal sympathetic hyperactivity with bromocriptine: a case report: Min-Seok Woo, Seong-Hyun Park, Jeong-Hyun Hwang, Chaejin Lee; Received January 22, 2025 Accepted February 23, 2025 Published online September 3, 2025; DOI: https://doi.org/10.20408/jti.2025.0016 [Epub ahead of print]

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Abstract PDF: This case report describes a unique instance of refractory paroxysmal sympathetic hyperactivity (PSH) in a 19-year-old woman following a traumatic brain injury sustained in a motorcycle accident. The patient presented in a semicomatose state with a Glasgow Coma Scale score of 3 (E1, VT, M2), a significant left frontotemporal subdural hematoma, and a midline shift that necessitated emergency craniectomy and hematoma evacuation. Postoperatively, she developed recurrent episodes of hyperthermia, tachycardia, hypertension, tachypnea, diaphoresis, rigidity, and eyeball deviation triggered by non-noxious stimuli. These episodes proved resistant to conventional treatments, including opioids, sedatives, and β-blockers. Based on the clinical presentation and a Paroxysmal Sympathetic Hyperactivity-Assessment Measure score of 28 (out of 29), a diagnosis of PSH was established. Bromocriptine was initiated at 0.025 mg/kg every 12 hours and later increased to every 8 hours, leading to a significant reduction in both the frequency and severity of episodes within days. Complete resolution of PSH episodes was observed by the sixth day of bromocriptine treatment, with no recurrence during the remaining treatment period. Bromocriptine was administered for a total of 1 month before being discontinued, and the patient remained symptom-free over a 10-month follow-up period. This case highlights the efficacy of bromocriptine in managing refractory PSH and underscores the importance of early recognition and targeted intervention for this rare but debilitating condition. Bromocriptine may offer a valuable therapeutic option for similar cases, particularly when conventional therapies fail.; Summary

Vertebral artery dissection and homonymous hemianopsia after a cervical spine fracture in a polytrauma patient with hypoplastic contralateral vertebral artery: a case report: Josip Lovaković, Dino Bobovec, Ivan Dobrić, Anko Antabak, Goran Milašin, Dino Papeš; Received January 16, 2025 Accepted April 14, 2025 Published online August 22, 2025; DOI: https://doi.org/10.20408/jti.2025.0014 [Epub ahead of print]

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Abstract PDF: Despite the increasing incidence of vertebral artery injury (VAI), it can often be overlooked during the management of polytrauma patients. Due to its specific anatomical location, the VA is particularly susceptible to both traumatic and spontaneous injuries. Traumatic VAI can result from blunt or penetrating trauma and is frequently associated with cervical spine injuries. An 18-year-old male patient was brought to the emergency department after being struck by a motor vehicle. The patient exhibited altered mental status while remaining normotensive and tachypneic. Notably, there were no visible injuries to the head or neck, though multiple contusions were present on the chest and abdomen. Radiographic imaging revealed a fracture of the transverse process of the seventh cervical vertebra, which caused dissection, thrombosis, and occlusion of the V1 segment of the left VA. Additionally, hypoplasia of the contralateral VA was observed. Given the presence of ultrasonographically confirmed free intra-abdominal fluid and the patient’s newly developed hemodynamic instability, he was urgently transferred to the operating theatre. A grade 3 liver laceration was discovered, and hemostasis was successfully achieved using direct sutures. After regaining consciousness, the patient reported right-sided homonymous hemianopsia accompanied by signs of cerebral ischemia. Following stabilization, he was started on anticoagulant and antiplatelet therapy. Upon discharge and during follow-up, the visual deficit persisted. This case emphasizes the importance of recognizing and managing VAI in polytraumatized patients. Furthermore, the rare combination of contralateral VA hypoplasia and VAI significantly influenced the development of neurological deficits.; Summary

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