Journal of Trauma and Injury

Inferior vena cava injuries at a level I trauma center: six case reports: Rachith Sridhar, Abdul Vakil Khan, Harendra Kumar, Abdul Hakeem, Deepak Kumar, Majid Anwer; Received March 7, 2025 Accepted April 11, 2025 Published online June 27, 2025; DOI: https://doi.org/10.20408/jti.2025.0054 [Epub ahead of print]

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Abstract PDF: 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.; Summary

Complex soft tissue injuries associated with portable charger detonation: four case reports from the war in Ukraine: Eduard Mykolaiovych Khoroshun, Vitaliy Volodymyrovych Makarov, Volodymyr Volodymyrovych Nehoduiko, Maksym Olegovych Malimonenko, Hannah B. H. Wild, Serhii V. Tertyshnyi; Received February 24, 2025 Accepted April 13, 2025 Published online June 25, 2025; DOI: https://doi.org/10.20408/jti.2025.0042 [Epub ahead of print]

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Abstract PDF: 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.; Summary

Silent ST elevation: unmasking blunt cardiac injury: a case report: Vasudha Dinesh, Arun A. Mohanan, Swetha Ramesh, Amaravathi Uthayakumar; Received February 17, 2025 Accepted April 10, 2025 Published online June 25, 2025; DOI: https://doi.org/10.20408/jti.2025.0034 [Epub ahead of print]

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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

Successful minimally invasive reduction surgery with a micro burr hole in a pediatric patient with depressed skull fracture: a case report: Seung Han Yu, Hyuk Jin Choi, Byung Chul Kim, Mahn Jeong Ha; Received January 21, 2025 Accepted April 14, 2025 Published online June 25, 2025; DOI: https://doi.org/10.20408/jti.2025.0015 [Epub ahead of print]

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Abstract PDF: 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.; Summary

Spontaneous resolution of papilledema and multilayered hemorrhages in Terson syndrome associated with subarachnoid hemorrhage: a case report: Shreyas Temkar, Hemanth Ramachandar, Astha Gupta, Amit Kumar Deb; Received December 16, 2024 Accepted April 2, 2025 Published online June 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0097 [Epub ahead of print]

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Abstract PDF: 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.; Summary

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: Doo-Hun Kim, Maru Kim, Dae-Sang Lee, Tae Hwa Hong, Hangjoo Cho; Received November 29, 2024 Accepted March 24, 2025 Published online June 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0087 [Epub ahead of print]

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Abstract PDF: 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.; Summary

Fatal fat embolism syndrome in a young trauma patient with a stable initial presentation: time to define predictive criteria? A case report: Nebojsa Brezic, Strahinja Gligorevic, Tatjana Atanasijevic, Vladimir Zivkovic, Bojan Jovanovic; Received October 23, 2024 Accepted February 6, 2025 Published online April 21, 2025; DOI: https://doi.org/10.20408/jti.2024.0072 [Epub ahead of print]

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Abstract PDF: Fat embolism syndrome (FES) is a rare but serious complication most commonly associated with trauma, particularly long bone fractures. However, symptomatic FES remains a significant diagnostic and therapeutic challenge. We present the case of a 20-year-old man who, after sustaining multiple long bone fractures in a motorcycle accident and initially appearing stable, experienced a rapid and fatal progression of FES. This case underscores the unpredictable course of FES even in young, previously healthy individuals and highlights the critical need for early recognition and intervention. It also emphasizes the importance of identifying risk factors that may predict severe outcomes and mortality.; Summary

Traumatic globe avulsion secondary to a penetrating orbital injury from a bicycle handlebar: a case report: Nishanth S. Iyengar, Edward Xie, Patricia Pahk, Nariman S. Boyle; J Trauma Inj. 2025;38(2):147-151. Published online April 1, 2025; DOI: https://doi.org/10.20408/jti.2024.0070

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Abstract PDF: A 60-year-old man presented with total avulsion of the right globe following a penetrating injury to the right orbit from a metal bicycle handlebar. There was no light perception in the right eye on presentation. External examination revealed a full-thickness, canalicular-involving, horizontal right upper eyelid laceration through which the luxated globe and other orbital contents extruded. The globe was intact. The patient underwent urgent surgical exploration. In the operating room the optic nerve and all extraocular muscles were found to be completely transected from the globe. The globe was enucleated, and the eyelid laceration was repaired with bicanalicular stent placement.; Summary

The SPAIRE (saving piriformis and internus, repair of externus) posterolateral approach in bipolar hemiarthroplasty for femoral neck fractures: a case report: Nazim Sifi, Sorin Suba; Received December 16, 2024 Accepted January 12, 2025 Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0099 [Epub ahead of print]

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Abstract PDF: Femoral neck fractures commonly occur in older patients and typically require surgical intervention to promptly restore mobility and minimize complications. While the anterior, lateral, and posterior approaches are frequently employed for hemiarthroplasty, each has its own benefits and drawbacks. Notably, the posterior approach has been linked to a higher risk of dislocation in some studies. The SPAIRE (saving piriformis and internus, repair of externus) technique is a modern adaptation of the traditional posterolateral approach. This less invasive, anatomically considerate method preserves the piriformis muscle tendon and the conjoint tendon of the superior gemellus, obturator internus, and inferior gemellus muscles. However, it involves sectioning the tendon of the obturator externus muscle. The technique is designed to maintain stabilizing muscular structures, decrease dislocation risk, and hasten functional recovery, including in patients with neurological conditions. This case report describes the treatment of a 79-year-old woman with a transcervical fracture of the right femoral neck. A bipolar hemiarthroplasty was performed using the SPAIRE technique. The procedure effectively preserved the functional synergistic unit of the piriformis-conjoint tendon (quadriceps coxa) and included meticulous capsular and tendinous repair. The patient's postoperative recovery was characterized by an excellent functional outcome at the 3-month follow-up. This case highlights the advantages of the SPAIRE technique in enhancing joint stability and facilitating rapid recovery, especially in geriatric patients.; Summary

Successful treatment of hemophagocytic lymphohistiocytosis in a trauma patient: a case report: Young Soo Chung, Jihoon Kim; J Trauma Inj. 2025;38(1):66-70. Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0093

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Abstract PDF: Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome characterized by excessive activation of the immune system. This case report describes an unusual presentation of HLH triggered by severe trauma from a motorcycle accident, which is a departure from traditional associations with infections, malignancies, or autoimmune conditions. A 40-year-old man with multiple traumatic injuries developed persistent fever, pancytopenia, and elevated inflammatory markers following orthopedic surgery. Despite empiric antibiotic therapy, his condition deteriorated, exhibiting high fever, skin rash, hepatic dysfunction, and marked elevation of ferritin levels (32,901 ng/mL). Bone marrow biopsy confirmed the diagnosis of HLH, and treatment was initiated according to the HLH-2004 protocol, which included methylprednisolone, intravenous immunoglobulin, and immunosuppressive therapy. The patient demonstrated significant clinical improvement and was discharged after 37 days, with no recurrence observed during the follow-up period. This case underscores the need to consider HLH in trauma patients presenting with unexplained inflammatory responses and illustrates that prompt diagnosis and aggressive treatment can lead to successful outcomes.; Summary

Resolution is not the end: The Macklin effect after chest tube removal in a trauma patient with aging and comorbidities: a case report: Faye Abdulkareem, Fayez G. Aldarsouni, Sahar Alomar, Zisis Touloumis, Hussain M. AlHassan, Ghassan Z. Al Ramahi, Tareq Alsabahi, Khaled Twier, Mohammad Alsenani, Emad Alamoudi; J Trauma Inj. 2025;38(2):159-164. Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0090

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Abstract PDF: 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.; Summary

Cerebral fat emboli monitoring using transcranial Doppler ultrasound and confirmation of a successful treatment response: a case report: Morgan Jude, Ryan Martin, Ivy Nguyen, Christine Cocanour, Heather Nicoletto, Keyanna Raihani, Alicia Alley, Jeffrey R. Vitt; J Trauma Inj. 2025;38(2):152-158. Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0075

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Abstract PDF: Fat emboli syndrome is a rare and potentially fatal condition that most commonly manifests after traumatic long-bone fractures. Cerebral fat emboli are one of the most feared complications leading to permanent neurologic injury, though methods for optimal monitoring in high-risk patients are lacking. We present a case of a 16-year-old female patient who presented to the emergency department following a motor vehicle collision with multiple injuries, including a comminuted femoral shaft and pelvic ring fracture, as well as an acute basilar artery occlusion due to fat embolism. Continuous transcranial Doppler ultrasound (TCD) of the bilateral middle cerebral arteries was utilized for emboli detection and evaluation of right-to-left shunt. The patient was found to have a high burden of microemboli on TCD in combination with a right-to-left shunt conferring increased risk of additional neurologic injury. Following surgical fixation of her orthopedic injuries, repeated TCD assessment demonstrated no further evidence of microemboli thus demonstrating efficacious response to definitive treatment. This report highlights the utility of TCD for early monitoring and detection of cerebral emboli in patients at risk for fat emboli syndrome as well as evaluating response to intervention.; Summary

Similarities and differences between lightning and electrical injuries: two case reports: Yi Liu, Zosimo Ken L. Jimeno, Wan Azman Wan Sulaiman; J Trauma Inj. 2025;38(2):137-141. Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0067

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Abstract PDF: Exposure to electrical current, whether through accidental contact in residential or industrial settings or via lightning strikes, represents a serious global health concern. Although numerous studies have been published on the differences between electrical and lightning injuries, they are often discussed together due to the similarities in their clinical presentations, management approaches, and outcomes. The question of whether electrical and lightning injuries should be studied together remains a matter of debate. Here, we present two cases: one of a lightning injury and another of an electrical injury. Our discussion aims to improve the understanding of lightning and electrical injuries as distinct entities. Vigorous resuscitative measures are recommended and given the complexity of electrical and lightning injuries and their long-term sequelae, patients should be managed in a multidisciplinary burn center. Furthermore, the knowledge and awareness of the general population must be improved to reduce the incidence of such injuries.; Summary

Successful laparotomy for intra-abdominal hypertension following veno-venous extracorporeal membrane oxygenation after severe thoracoabdominal trauma: a case report: Yo Huh, Jonghwan Moon, Kyoungwon Jung, Hye-Min Sohn; J Trauma Inj. 2025;38(2):142-146. Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0060

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Abstract PDF: Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is often used as a life-saving therapy for lung injuries; however, it presents challenges, including bleeding risks and potential reductions in ECMO flow. This case report details the intricate management of a 16-year-old boy who suffered severe thoracoabdominal trauma following a nine-floor fall. The patient sustained severe lung injury and damage to multiple solid organs, including liver lacerations, and was placed on VV-ECMO. When initiating ECMO, it is crucial to carefully consider anticoagulation to avoid potential bleeding complications. Therefore, despite the usual risks associated with ECMO, such as bleeding and reduced flow rates, anticoagulation was withheld due to the risk of hemorrhage from the liver injury. While on ECMO support, the patient experienced a sudden decrease in flow and blood pressure, suggesting an increase in intra-abdominal pressure. An immediate decompressive laparotomy revealed a significant hemoperitoneum, primarily caused by oozing from the liver laceration. The prompt recognition of abdominal distension and the timely decision to proceed with surgery without further imaging were key to the successful treatment. Postoperatively, the patient showed good recovery, with gradual weaning from ECMO, extubation, and eventual discharge. In conclusion, this case highlights the importance of ongoing monitoring for patients with complex trauma who are on ECMO. External factors, including elevated intra-abdominal pressure, can impair ECMO performance. Meticulous management and a multidisciplinary approach are essential in these intricate cases, which involve the nonsurgical treatment of solid organ damage accompanied by severe lung injury.; Summary

Liver laceration as a post-cardiopulmonary resuscitation complication in a person with breast implants: a case report: Min-Jeong Cho; J Trauma Inj. 2024;37(4):300-303. Published online December 16, 2024; DOI: https://doi.org/10.20408/jti.2024.0077

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Abstract PDF: Cardiac compression is the most crucial component of successful cardiopulmonary resuscitation (CPR). However, CPR procedure poses a risk of complications, even when CPR providers perform cardiac compressions as recommended. Reports indicate that solid organ injuries, including liver injuries, occur with an incidence of about 0.6% to 3%. In this particular case, a 25-year-old woman was found hanged in her apartment. She was transported to a nearby hospital where CPR was administered for approximately 30 minutes until she was resuscitated. Subsequently, an abdomen-pelvis computed tomography scan revealed a liver injury. The location of the liver injury, between the sternum and spine, suggested it was a compression injury caused by CPR. There was no evidence of extravasation or active bleeding; thus, conservative management was chosen for the liver injury. By hospital day 4, the patient's pupil reflex had completely disappeared. Electroencephalography showed generalized attenuation, indicating severe global brain damage. Liver injury is a relatively rare post-CPR complication, with an incidence of 0.6% according to a retrospective analysis of a cardiac arrest registry. The liver is partially situated between the sternum and spine. The end of the sternum is shaped like an inverted triangle, resembling a sword. Therefore, if the CPR provider's hands are placed too low or excessive pressure is applied, the sternum can injure the left liver. Blood loss from liver injuries could potentially hinder the successful resuscitation of patients. In this case, had there been no blood loss from the liver injury, the patient might have maintained better cerebral perfusion and function.; Summary

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