Journal of Trauma and Injury

Original Article

Functional outcomes of salvage hip arthroplasty in failed proximal femoral nails: a retrospective cohort study: Bushu Harna, Dinesh Sandal, Shivali Arya; J Trauma Inj. 2026;39(2):128-136. Published online June 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0206

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Abstract PDF: Purpose
Intertrochanteric femur fractures treated with proximal femoral nails (PFNs) may develop complications such as screw cutout, nonunion, and varus collapse, which can necessitate salvage procedures including hip arthroplasty. This study aimed to evaluate the surgical challenges, operative techniques, and outcomes of hip arthroplasty performed after failed PFN fixation.
Methods
A total of 59 patients who underwent hip arthroplasty following PFN failure for intertrochanteric femur fractures were enrolled. Collected data included patient demographics, fracture characteristics, PFN failure patterns, surgical techniques, complications, and functional outcomes.
Results
The most common PFN failure patterns were screw backout, cutout, screw breakage, and nail breakage. These cases were managed with salvage hip arthroplasty, including hemiarthroplasty and total hip arthroplasty, depending on patient-specific factors. Intraoperative challenges involved implant removal and management of bone defects. Reported complications included dislocation, deep vein thrombosis, and periprosthetic fractures. The mean Harris Hip Score at 24 months was 79.2.
Conclusions
Hip arthroplasty serves as an effective salvage option for failed PFN fixation in intertrochanteric femur fractures. However, it presents distinct surgical challenges and requires careful patient selection and meticulous technique to reduce the risk of complications.; Summary

Review Article

Clinical practice guideline recommendations for orthopedic surgical management of traumatic hip fractures: a systematic review: Tia Kalise Shutes, Kaylan Nicole Johnson, Emily Wayent Blevins, Madeline Grace Shipley, Saurabh P. Mehta; J Trauma Inj. 2026;39(2):110-118. Published online May 4, 2026; DOI: https://doi.org/10.20408/jti.2025.0105

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Abstract PDF Supplementary Material: Purpose
Hip fractures pose a critical orthopedic challenge, disproportionately affecting older adults and significantly compromising mobility and independence. The complexity of both the injury and the patient profile necessitates adopting best practices grounded in research evidence to optimize surgical management and recovery. This study comprehensively evaluated the quality and clinical applicability of existing clinical practice guidelines (CPGs) for the orthopedic surgical management of traumatic hip fractures and summarized key practice recommendations.
Methods
A systematic literature search was performed across five databases (PubMed, CINAHL, Scopus, Embase, and PEDro) for CPGs published since January 2000. Two reviewers independently identified eligible CPGs using predefined criteria. The methodological quality of eligible CPGs was assessed using the AGREE II tool, which examines quality across the domains of scope, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. The complementary AGREE-REX tool was used to assess the guidelines’ clinical relevance and applicability.
Results
Six CPGs were critically appraised, and two demonstrated high methodological quality scores (2009 SIGN and 2023 NICE CPGs). Across all CPGs, there was consensus emphasizing surgical timing within 24 to 48 hours after a hip fracture. In addition, most CPGs recommended against the use of preoperative traction. Recommendations for diagnostic imaging were supported by limited high-quality evidence. Domains addressing target users’ values and resource feasibility scored lowest across CPGs, diminishing implementability.
Conclusions
Fewer than half of the appraised CPGs were rated high quality, and important clinical practice domains were insufficiently addressed. Orthopedic surgeons should follow recommendations to perform operative intervention within 24 to 48 hours after injury and avoid preoperative traction. The findings also underscore the need to develop CPGs with higher methodological rigor and more actionable practice recommendations.; Summary

Original Article

Clinical and radiological outcomes of bimalleolar ankle fractures treated with open reduction and internal fixation: a prospective observational study: Kumar VSV, Velmurugan Srinivasan, Rajasekar S, Muthu Adaikkappan, Hemapriya A S; J Trauma Inj. 2026;39(1):60-67. Published online March 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0180

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Abstract PDF: Purpose
Bimalleolar ankle fractures are common injuries that typically result from trauma such as falls or road traffic accidents. Open reduction and internal fixation (ORIF) is the standard treatment and aims to restore proper alignment, stability, and ankle function. Despite the overall effectiveness of ORIF, patient outcomes may vary depending on age, sex, fracture type, and the timing of surgery. This study evaluates the clinical, radiological, and functional outcomes of bimalleolar ankle fractures treated with ORIF and identifies factors influencing recovery and complications.
Methods
A prospective observational study was conducted from January 2024 to January 2025. Forty patients over 18 years of age with bimalleolar ankle fractures who were medically fit for surgery were included. Patients with previous ankle fractures, significant comorbidities, or contraindications to surgery were excluded. All participants underwent ORIF and were assessed at 6, 12, and 24 weeks postoperatively for clinical, radiological, and functional outcomes. Functional results were evaluated using the Baird-Jackson scoring system.
Results
The mean age of patients was 44.1 years and 18 (45.0%) were male. The right ankle was affected in 25 cases (62.5%). Most injuries resulted from slips and falls (57.5%), followed by road traffic accidents (42.5%). Supination-external rotation fractures (55.0%) were the most common pattern. The average time to radiological union was 14 weeks. At final follow-up, 28 patients demonstrated excellent functional outcomes, 10 had good outcomes, and 2 had fair results. The complication rate was low, with superficial wound infection and implant prominence each occurring in two patients (5.0%).
Conclusions
ORIF provides favorable clinical and functional outcomes for bimalleolar ankle fractures, with most patients achieving good or excellent recovery. Timely surgery and stable fixation are essential to reducing complications. Sex had a slight influence on union time, whereas age, fracture type, and the affected side did not significantly impact outcomes.; Summary

Case Report

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

Original Article

Thirteen-year trend analysis of orbital blowout fractures: shifts in mechanisms and ocular sequelae across two Korean trauma centers (2011–2023): Minhee Hwang, Youngjun Kim, Changryul Claud Yi; J Trauma Inj. 2025;38(4):353-359. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0164

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Abstract PDF: Purpose
This study aimed to examine 13-year changes in the injury mechanisms of orbital blowout fractures (OBFs) in Korea and to determine how those changes influenced preoperative ocular motility deficits, while also assessing whether apparent intercenter differences persisted after covariate adjustment.
Methods
A retrospective cohort was assembled from two level I trauma centers: a historical 2011 series from Inje University Sanggye Paik Hospital (n=150) and a pooled 2019–2023 series from Pusan National University Hospital (n=50). Eligibility required computed tomography–confirmed medial and/or inferior wall fracture with an intact orbital rim; patients with rim involvement or penetrating ocular trauma were excluded. Injury mechanism, fracture site, and diplopia and/or extraocular movement (EOM) limitation at presentation were abstracted from electronic medical records. Categorical comparisons used the chi-square test, and trends across calendar years were assessed using logistic regression (with year as a continuous predictor). Multivariable logistic modeling estimated adjusted odds ratios (aORs) for preoperative ocular motility deficit according to age, sex, mechanism, fracture site, calendar year, and center, with robust clustering.
Results
Interpersonal violence decreased from 34.7% of OBFs in 2011 to 14.0% in 2019–2023, representing an 11% annual decline (OR, 0.89; 95% confidence interval [CI], 0.81–0.97, P=0.007). Preoperative diplopia or EOM limitation was observed in 23 of 200 patients (11.5%): 14% in 2011 versus 4% in 2019–2023. Independent predictors of EOM limitation were interpersonal violence (aOR 3.84; 95% CI, 1.38–10.65; P=0.010) and male sex (aOR, 4.78; 95% CI, 1.49–15.49; P=0.009). Age showed a protective trend (aOR, 0.75 per decade; P=0.064); fracture extent and center were not significant after adjustment. Calendar year showed a borderline inverse association (aOR, 0.86; P=0.061), indicating a 14% annual reduction in presentation-time deficit.
Conclusions
Between 2011 and 2023, the Korean OBF landscape shifted from violent assault to accidental mechanisms, accompanied by a marked decline in preoperative ocular motility impairment. Assault mechanism and male sex remain strong risk indicators, while center-based differences appear largely explained by temporal composition. Public health efforts that reduce violence may therefore translate directly into better functional status at initial presentation.; Summary

Case Report

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

Original Article

Artificial intelligence models for predicting pulmonary complications in patients with chest trauma: a retrospective study: Junepill Seok, Jinseok Lee, Wu Seong Kang; J Trauma Inj. 2025;38(3):237-247. Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0100

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Abstract PDF: Purpose
Pulmonary complications, including pneumonia and respiratory failure, continue to be major contributors to morbidity and mortality in patients with chest trauma. Although several artificial intelligence (AI) models have been developed to predict trauma mortality, there remains a lack of AI-based prediction models specifically targeting pulmonary complications in chest trauma. To address this gap, we developed and validated an explainable AI model for predicting pulmonary complications.
Methods
This retrospective analysis included 1,040 patients with blunt chest trauma who were treated at a single regional trauma center between January 2019 and March 2023. Pulmonary complications were defined as pneumonia, prolonged mechanical ventilation (>48 hours), or other major thoracic complications necessitating surgical intervention. Machine learning algorithms, including extreme gradient boosting (XGBoost), random forest, adaptive boosting (AdaBoost), light gradient boosting machine (LightGBM), and a deep neural network, were trained using hyperparameter tuning and threefold cross-validation. Model performance was evaluated by sensitivity, specificity, accuracy, balanced accuracy, F1 score, and the area under the receiver operating characteristic curve (AUC). Model interpretability was assessed using Shapley Additive Explanations (SHAP) values.
Results
Among the total cohort, 188 patients (18.1%) developed pulmonary complications. In the independent testing dataset (n=208), XGBoost achieved the highest AUC (0.856), while AdaBoost demonstrated the highest balanced accuracy (0.779). All machine learning models outperformed conventional scoring systems. SHAP analysis identified key predictors of pulmonary complications, including age, Injury Severity Score, Glasgow Coma Scale score, Abbreviated Injury Scale of the extremity or head, initial PaO2 to fraction of inspired oxygen ratio, location of the primary rib fracture, and presence of flail motion.
Conclusions
The developed AI model accurately predicts pulmonary complications in patients with chest trauma and outperforms traditional prognostic tools. The model's explainability offers actionable clinical insights, supporting early risk stratification and evidence-based decision-making in trauma care.; Summary

Case Reports

Penetrating orbital floor injury by an undetected foreign body: a case report: Simon Chummar, Yamini Ghatikar, K Thoi Thoi Singha, Divya Ann Mathews; J Trauma Inj. 2026;39(1):75-79. Published online September 3, 2025; DOI: https://doi.org/10.20408/jti.2025.0025

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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

Open total talar dislocation treated with reimplantation of the talus and reverse adipofascial sural flap: a case report: Antonio Gilli, Maria Gabriella Lettera, Neomi Stefanetti, Georgios Touloupakis, Emmanouil Theodorakis, Elisa Pernigotti, Guido Antonini; J Trauma Inj. 2025;38(3):280-284. Published online August 22, 2025; DOI: https://doi.org/10.20408/jti.2025.0010

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Abstract PDF

Talar extrusion is an extremely rare injury, with few cases described in the literature. Treatment options vary and are primarily determined by the degree of soft tissue involvement and the surgeon’s experience. Good or acceptable outcomes have been reported with talar reimplantation, even in cases of open dislocations with severe contamination. However, a high complication rate has been observed, with infections and avascular necrosis of the talus representing the most frequent complications. The aim of this study is to present a case of open talar dislocation that was successfully treated. An 18-year-old male patient with an open talar extrusion and severe soft tissue damage was treated with reimplantation of the talus, yielding favorable results. Soft tissues were simultaneously reconstructed using a reverse adipofascial sural flap. The patient remained infection-free, and no signs of avascular necrosis were observed 1 year after the trauma.

Summary

Citations

Citations to this article as recorded by

Midshaft tibial osteotomy and bone transport for tibiocalcaneal arthrodesis
Sunwen Pan, Bo Wang, Zeyu Zhao, Xiaokang Gong, Yueliang Zhu, Zhen Shi
Frontiers in Surgery.2026;[Epub] CrossRef

Original Article

Dual plating in the management of nonunion complex distal femur fractures following lateral locked plate fixation: radiological and functional outcomes of a prospective study: Nilesh Barwar, Gypsy Gargi, Ankit Rai, Abhay Elhence, Sumit Banerjee, Nitesh Gahlot; J Trauma Inj. 2025;38(2):125-136. Published online June 27, 2025; DOI: https://doi.org/10.20408/jti.2024.0054

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Abstract PDF

Purpose
Managing complex distal femur fractures presents technical challenges. Although the lateral locked plate has become standard for these fractures, failures are not uncommon when this device is used alone. Patients with nonunion of distal femur fractures following treatment with a single lateral locked plate were examined. Revision surgery was performed by applying dual plates, and their efficiency was evaluated.
Methods
This study investigated 24 aseptic and 3 septic nonunions of distal femur fractures, classified as AO/OTA type C, that were previously managed with open reduction and internal fixation using only a lateral locked plate. Revision surgery involved replacing the broken 5.0-mm lateral locked plate, supplementing the medial side with a 4.5-mm T-plate, and applying bone grafting at the fracture site. Septic cases were managed using a staged approach with dual implant application.
Results
Following revision surgery, bony union was achieved in 83.3% of aseptic nonunions, with a mean bone healing time of 22.5 weeks (range, 15–27 weeks). Additional surgery was required for the remaining 16.6%. Using staged management, the septic nonunions were united in a mean of 30.25 weeks (range, 27–32 weeks). Significant improvements were noted in the Tegner Lysholm Knee Scoring Scale, with median preoperative and postoperative scores of 30 (range, 12–67) and 80 (range, 66–90), respectively (P<0.001). Limb pain, as measured by the visual analog scale for knee pain, improved significantly from a preoperative median of 6 (range, 4–8) to 3 (range, 1–6) postoperatively (P<0.001). All patients were ambulatory without supportive devices. However, the mean knee range of motion was 80° (range, 40°–120°). Limb shortening was observed in six cases (22.2%; average shortening, 2.3±1.0 cm).
Conclusions
Dual plating appears to be an effective approach for managing failed complex distal femur fractures following initial treatment with a single lateral locked plate.

Summary

Citations

Citations to this article as recorded by

Paradigm Shift in the Management of Delayed Union and Nonunion of Junctional Fractures of the Lower Limb
Sushrut Babhulkar, Nitin Kimmatkar, Samir Dwidmuthe
Indian Journal of Orthopaedics.2026; 60(5): 1046. CrossRef
Does dual-plating offer superior stability in complex distal femoral fracture management?
Ahmed Naser Elbarbary, Ismail Tawfeek Badr, Emad Badawy, Rasha Yousry Kamel Saleh
Journal of Orthopaedic Surgery and Research.2026;[Epub] CrossRef
Augmented 3.5 mm plates with 3.5/4.5 mm locked plates for treating failed diaphyseal long bone fractures- the ‘Dual Plate’ Technique: A multicentric analysis of 86 neglected patients
Nishit Palo, Mahima Lakhanpal, Priti Ranjan Sinha, Abhishek Shukla, Govind Narayan Choudhary
Journal of Clinical Orthopaedics and Trauma.2026; 82: 103564. CrossRef
Nonunion in Long Bone Fractures: A Comprehensive Review of Current Treatment Strategies
Ahmed Mohamed, Daniel Francis, Usman Fuad, Nabil Elmaleh, Ahmed Nagi
Cureus.2025;[Epub] CrossRef

Case Reports

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; J Trauma Inj. 2025;38(3):307-311. Published online June 25, 2025; DOI: https://doi.org/10.20408/jti.2025.0015

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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

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; J Trauma Inj. 2025;38(3):273-279. Published online April 21, 2025; DOI: https://doi.org/10.20408/jti.2024.0072

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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

Citations

Citations to this article as recorded by

Severe Traumatic Cerebral Fat Embolism Following Pelvic Fracture: A Case Report and Literature Review
Jung Woo Hyung, Maru Kim, Tae-Kyu Lee, Min Ho Lee
Korean Journal of Neurotrauma.2025; 21(4): 317. CrossRef

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; J Trauma Inj. 2025;38(3):268-272. Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0099

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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

Traumatic arterial thoracic outlet syndrome after multiple rib fractures not including the first rib in Korea: a case report: Seock Yeol Lee; J Trauma Inj. 2024;37(2):158-160. Published online June 5, 2024; DOI: https://doi.org/10.20408/jti.2023.0081

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Abstract PDF: Arterial thoracic outlet syndrome (TOS) resulting from thoracic trauma is an exceedingly rare condition, typically caused by a fracture of the first rib or clavicle. In this report, the author presents a case of traumatic arterial TOS precipitated by multiple left rib fractures, notably excluding the first rib, following a fall from a 2-m high stepladder. The patient was treated successfully with first rib resection via a transaxillary approach, and the postoperative course was uneventful. The literature includes no known reports of traumatic arterial TOS in patients with multiple fractures that spare the first rib, making this the first documented case of its kind. In this instance, the patient sustained fractures to the fourth and fifth ribs. The TOS was likely not a direct result of the multiple rib fractures, which were located some distance from the thoracic outlet. Rather, it is hypothesized that the trauma from these fractures caused a soft tissue injury within the thoracic outlet, which ultimately led to the development of TOS.; Summary

Atypical Vancouver B1 periprosthetic fracture of the proximal femur in the United Kingdom: a case report challenged by myeloma, osteoporosis, infection, and recurrent implant failures: Sayantan Saha, Azeem Ahmed, Rama Mohan; J Trauma Inj. 2024;37(1):89-96. Published online March 18, 2024; DOI: https://doi.org/10.20408/jti.2023.0069

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Abstract PDF

The indications for total hip replacement are increasing and not limited to osteoarthritis. Total hip replacement may also be done for trauma and pathological fractures in patients otherwise physiologically fit and active. This trend has led to an inevitable rise in complications such as periprosthetic femoral fracture. Periprosthetic femoral fracture can be challenging due to poor bone quality, osteoporosis, and stress fractures. We present a case of periprosthetic femoral fracture in a 71-year-old woman with some components of an atypical femoral fracture. The fracture was internally fixed but was subsequently complicated by infection, implant failure needing revision, and later stress fracture. She was on a bisphosphonate after her index total hip replacement surgery for an impending pathological left proximal femur fracture, and this may have caused the later stress fracture. Unfortunately, she then experienced implant breakage (nonunion), which was treated with a biplanar locking plate and bone grafting. The patient finally regained her premorbid mobility 13 months after the last surgery and progressed satisfactorily towards bony union.

Summary

Citations

Citations to this article as recorded by

Characteristics and Risk Factors of Atypical Periprosthetic Femoral Fractures Following Total Hip Arthroplasty: A Systematic Review and Meta-Analysis
Ayomide Michael Ade-Conde, Ahmad Hamade, Omar Al-Mohrej, Vickas Khanna, James Yan
Arthroplasty Today.2026; 39: 102048. CrossRef

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