Journal of Trauma and Injury

Original Articles

C1-ring osteosynthesis for Jefferson fracture: a multi-institutional retrospective case series: Hangeul Park, Woojin Kim, Jungbo Sim, Ho Sung Myeong, Seunghoon Lee, Jun-Hoe Kim, Chang-Hyun Lee, Fon-Yih Tsuang, Chi Heon Kim; J Trauma Inj. 2026;39(3):234-240. Published online September 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0232

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Abstract PDF: Purpose
C1-ring osteosynthesis is gaining attention as a motion-preserving alternative for treating type III Jefferson fracture. This study evaluated its clinical and radiological outcomes, especially in cases involving partial transverse atlantal ligament (TAL) injury.
Methods
This retrospective study reviewed patients who underwent C1-ring osteosynthesis for traumatic type III Jefferson fracture at two institutions between January 2011 and December 2024. Preoperative and postoperative medical records, radiographs, magnetic resonance imaging, and computed tomography were reviewed to assess fracture type, TAL injury, anterior atlantodental interval (AADI), and posterior atlantodental interval (PADI).
Results
Eight patients (mean age, 49.1±20.0 years; 87.5% male) were included. Seven patients (87.5%) had type III Jefferson fractures, and one patient had a type III Jefferson fracture with lateral mass involvement. Partial TAL injury was identified in six patients. The mean follow-up period was 40.0±9.9 months. No postoperative neurological deficits or surgery-related complications were reported. Complete C1 ring fusion was achieved in six patients (75.0%) within 13.3±8.5 months. Two patients achieved fusion only at the posterior arch, with the anterior arch remaining unfused but without displacement. At the last follow-up, the C2–C7 Cobb angle was −17.7°±6.6°, and the cervical range of motion was 59.1°±22.6°. Seven patients (87.5%) had a flexion AADI greater than 3 mm; however, the difference in AADI between flexion and extension was within 2 mm, and the PADI was maintained at an acceptable level (16.0±1.2 mm).
Conclusions
C1-ring osteosynthesis provided effective anatomical reduction, solid fusion, and favorable preservation of cervical motion in patients with type III Jefferson fracture, including those with partial TAL injury. These findings support its clinical utility as a motion-preserving alternative to posterior intersegmental fusion. Prospective studies with larger cohorts and comparative controls are warranted to validate these results.; Summary

Year-round consistency in upper extremity trauma surgery in Florida: challenging the concept of “trauma season”: a retrospective study: Anshumi Desai, Rohan Mangal, Daniel Garcia, Mitchell A. Pet, Kashyap K. Tadisina; J Trauma Inj. 2026;39(3):256-263. Published online September 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0154

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Abstract PDF Supplementary Material: Purpose
Upper extremity (UE) trauma requiring surgery in the United States typically peaks during the summer and fall; however, Florida’s climate may create a distinct temporal pattern. This study analyzes year-round UE trauma surgery volumes at a South Florida academic medical center to explore the potential impact of environmental factors.
Methods
Current Procedural Terminology (CPT; standardized codes used to report medical and surgical procedures) databases were analyzed to identify acute UE trauma codes over a 132-month period, and surgical volume was tabulated accordingly. Raw data were plotted as a time series and subsequently converted to a moving average ratio. Autocorrelation analysis was performed to assess yearly periodicity, and multivariable modeling evaluated variability attributable to this periodicity. A subanalysis examined periodicity across three predefined age groups.
Results
A total of 5,924 CPT codes were included in the analysis. The highest monthly volume of UE trauma–related CPT codes occurred in March (49.5 codes per month), whereas the lowest volume occurred in June (41.7 codes per month), yielding a difference of 7.8 codes. No consistent patterns were observed with respect to higher case volumes by specific months or seasons. Time series analysis across the 132-month period demonstrated an overall trend of volume growth without evidence of annual fluctuation. Autocorrelation analysis revealed no yearly periodicity in UE trauma CPT volumes, including after weekend-specific subanalysis. In age-stratified models, results remained nonsignificant: 18–44 years (R2=0.10, P=0.401), 45–64 years (R2=0.10, P=0.369), and ≥65 years (R2=0.13, P=0.133).
Conclusions
UE trauma operations were consistently distributed throughout the year, with no distinct periodic fluctuations identified across weekends or age groups in Florida. These findings suggest that weather-related factors may contribute to the seasonal patterns observed in other geographic regions.; Summary

Association between craniofacial trauma and traumatic brain injury in patients admitted to a tertiary care hospital: a prospective cross-sectional study: Peer Asad Aziz, Abdul Wajid, Etizaz Ahmed, Arslan Mehmood, Babar Ali Qureshi, Hameedullah Khan, Zeeshan Nasir Bhatti; J Trauma Inj. 2026;39(3):249-255. Published online September 30, 2026; DOI: https://doi.org/10.20408/jti.2025.0068

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Abstract PDF: Purpose
Craniofacial trauma and traumatic brain injuries (TBIs) frequently coexist due to their close anatomical proximity, making it essential to understand their correlation for optimal patient management. This study examines the association between specific types of craniofacial fractures and corresponding brain injuries in patients admitted to a tertiary care hospital.
Methods
A prospective cross-sectional study was carried out in the Department of Neurosurgery, Liaquat University of Medical and Health Sciences, from October 2024 to February 2025. Fifty-six patients with both craniofacial and brain injuries were included. Data collection involved systematic clinical evaluation, imaging studies, and statistical analyses using Pearson correlation coefficients, Spearman correlation coefficients, and ordinal logistic regression.
Results
The most common mechanism of injury was road traffic accidents (87.5%), and the most frequent craniofacial injuries were midface fractures (82.1%), with zygomaticomaxillary complex and naso-orbito-ethmoid fractures showing a significant association with pneumocephalus (P<0.05). Le Fort type I fractures were associated with subarachnoid hemorrhage. Patients with more than two midface fractures were 4.16 times more likely to sustain brain injuries (B=1.069; 95% confidence interval [CI], 0.301–1.837; P=0.006). Frontal air sinus fractures, especially with bilateral and both-table involvement, were strongly correlated with contusions and pneumocephalus (B=1.627; 95% CI, 0.569–2.684; P=0.003). Palatal fractures demonstrated a significant association with diffuse axonal injury (P=0.032).
Conclusions
The study highlights a significant correlation between craniofacial fractures and TBI severity, highlighting the importance of early detection and multidisciplinary management. Further large-scale studies are warranted to refine predictive models and improve clinical outcomes.; Summary

Case Report

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

Original Article

A 9-year retrospective study of vascular trauma at a suburban level I trauma center: patterns, predictors, and outcomes: Yasaswi V. Vengalasetti, Akito Theodore Nicol, Nwe Oo Mon, Sara Cardozo-Stolberg, Elizabeth Swezey, Anantha K. Ramanathan; Received May 1, 2025 Accepted August 20, 2025 Published online August 19, 2026; DOI: https://doi.org/10.20408/jti.2025.0101 [Epub ahead of print]

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Abstract PDF: Purpose
The objective of this study was to describe the epidemiology, mechanisms of injury, and outcomes of vascular trauma patients admitted to an American College of Surgeons level I trauma center located in a predominantly suburban county on Long Island, New York, United States, and to compare these findings with the existing literature.
Methods
This retrospective observational study used data collected from the hospital’s trauma registry for all patients with documented vascular trauma between January 2015 and December 2023, identified through relevant ICD-9 and ICD-10 codes.
Results
The trauma registry query identified 208 vascular trauma cases out of 12,617 total trauma cases (1.7%). The overall mortality rate was 19.7%, and the amputation rate was 2.4%. Patients were predominantly male, with a mean age of 40 years. Black and Hispanic patients were disproportionately affected. Most injuries were blunt, and these were associated with higher Injury Severity Scores (ISS), lower Glasgow Coma Scale (GCS) scores, and longer hospital length of stay (LOS). Multivariate analysis demonstrated a significant overall effect of mechanism of injury (blunt vs. penetrating) on ISS, GCS, and hospital LOS. Truncal injuries carried higher mortality than face/neck and extremity injuries.
Conclusions
Although relatively uncommon, vascular trauma remains associated with significant morbidity and mortality, particularly in blunt mechanisms and truncal injuries. The findings highlight the importance of regional epidemiological surveillance and raise concerns about racial disparities. These results emphasize the need for targeted prevention efforts, improved resource allocation, and further research to address the social and clinical factors underlying poor outcomes in vascular trauma.; Summary

Case Reports

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

Original Article

Patterns of penetrating trauma in New York City before, during, and after the COVID-19 pandemic: Elias Youssef, Bonny J. Baron, Andrew Sweeny, Hossein Kalantari, Roshanak Benabbas, Valery Roudnitsky, Donald Doukas, Hope A. Taitt, Nathanaens O. Estervil, Shahriar Zehtabchi; J Trauma Inj. 2026;39(1):52-59. Published online March 31, 2026; DOI: https://doi.org/10.20408/jti.2025.0196

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Abstract PDF: Purpose
The COVID-19 pandemic profoundly impacted multiple sectors of society, including healthcare. Major cities such as New York City (NYC) saw shifts in injury numbers and patterns during this period, underscoring the need to track these fluctuations to optimize resource allocation, improve trauma protocols, and inform public health policy. We examined trends in penetrating trauma in NYC before, during, and after the COVID-19 pandemic.
Methods
This retrospective cohort study used data from the NYC Health + Hospitals, which includes 11 acute care hospitals and trauma centers citywide. We analyzed electronic medical records from five level I trauma centers and one level II trauma center (pediatric level I) from August 1, 2019, to November 30, 2024. The study included patients with penetrating injuries and excluded minor-mechanism penetrating injuries or those incompatible with stab or gunshot mechanisms. Patients presenting for follow-up of prior injuries were excluded. The study timeframe was divided into three periods: pre–COVID-19 (August 1, 2019–February 29, 2020), COVID-19 (March 1, 2020–December 31, 2021), and post–COVID-19 (January 1, 2022–November 30, 2024). Descriptive statistics were used to summarize demographic and injury characteristics. Proportions are reported as percentages and continuous variables as medians with interquartile ranges (IQRs).
Results
Data for 9,118 patients were analyzed. Most were male (87.5%), with a median age of 30 years (IQR, 23–39 years). The incidence of penetrating trauma increased significantly during the COVID-19 period (164 cases per month) compared with pre–COVID-19 (110 cases per month) and post–COVID-19 (136 cases per month). Stab wounds were the most common injury type across all periods (53.7%).
Conclusions
Penetrating trauma cases increased notably during the COVID-19 pandemic in NYC, consistent with nationwide trends. Although not directly measured, socioeconomic stressors such as economic instability, social isolation, and substance abuse are plausible contributors to this increase.; Summary

Case Reports

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

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

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; J Trauma Inj. 2026;39(1):94-103. Published online February 4, 2026; DOI: https://doi.org/10.20408/jti.2025.0080

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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

Original Articles

Vascularized tissue coverage of trauma and acute care surgery defects with ovine forestomach matrix: interim results of a prospective multicenter study: Michael T. Cormican, W. Matthew Vassy, Carolyn Cook, Christopher A. Butts, John Loftus, Jessica Simon, D. Adam Young, Alison A. Smith; J Trauma Inj. 2026;39(1):42-51. Published online January 20, 2026; DOI: https://doi.org/10.20408/jti.2025.0090

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3 Web of Science
5 Citations

Abstract PDF Supplementary Material

Purpose
Traumatic soft tissue defects present challenges due to their diverse presentations. This variability necessitates tailored approaches for effective management, requiring advanced reconstruction strategies to achieve rapid coverage and tissue infill while minimizing complications. The study aimed to evaluate the safety of ovine forestomach matrix (OFM) grafts in traumatic defects from four level I trauma centers.
Methods
This prospective observational study used a multicenter registry to collect deidentified data from adult trauma/acute care surgery patients who received OFM-based grafts for soft tissue repair from August 2022 through September 2024. After the application of OFM grafts, defects were regularly assessed for the development of vascularized tissue coverage and/or fill, and ultimately epithelialization.
Results
During the study, 49 participants with 61 soft tissue defects underwent procedures with OFM-based grafts. The mean participant age was 58.8±17.7 years. Most defects (55.7%) resulted from traumatic injuries, with additional etiologies including necrotizing soft tissue infections (13.1%), enterocutaneous fistulas (4.9%), acute pressure injuries (stages III and IV, 6.6%), surgical dehiscence (4.9%), amputations (3.3%), and hematoma evacuation (3.3%). All defects achieved vascularized tissue coverage within a median of 22.5 days (interquartile range, 13.3–33.5 days) after a median of one product application (interquartile range, 1–1). Four cases of superficial infection were reported, all resolving without major complications.
Conclusions
OFM-based grafts showed promising results in tissue regeneration for trauma and acute care defects, with minimal postoperative complications. These results are interim findings from an ongoing prospective multicenter registry study evaluating the safety and efficacy of OFM-based grafts in various surgical applications.

Summary

Citations

Citations to this article as recorded by

Reconstruction of Deep Partial-Thickness Burns With Ovine Forestomach Matrix: Results From a Prospective Observational Study
Patrick J Kennedy, Michael Young, Kylie Wentworth, Nidhi Aravapalli, Nicole P Bernal, Ariel Rodgers, Laura Pezzopane, Beth McGuire, Jessica Simon, D. Adam Young, John Loftus
Cureus.2026;[Epub] CrossRef
Ovine forestomach matrix for wound treatment: an integrative review
Marcos Fortes, João Moreira, Ana Carolina Fernandes, Débora Wilbert
European Journal of Plastic Surgery.2026;[Epub] CrossRef
Surgical management of stage 3 and 4 pressure injuries in trauma patients using ovine forestomach matrix grafts: a prospective case series
Sophia M. Trinh, Kaitlyn Andre, Ada I. Özcan, Dhanushka S. Vitharana, Paige E. Deville, Joseph W. Mason, John P. Hunt, Alan B. Marr, Patrick P. Greiffenstein, Lance E. Stuke, Alison A. Smith
Frontiers in Surgery.2026;[Epub] CrossRef
Multi‐Centre, Single‐Arm, Prospective Evaluation of Ovine Forestomach Matrix for the Treatment of Complex Wounds in the South Asian Population
Salesh K. Soni, Ritesh Panda, Mohan G. Kakola, Jasleen Kaur, Brandon A. Bosque, Barnaby C. H. May
International Wound Journal.2026;[Epub] CrossRef
Safety of Ovine Forestomach Matrix Across 474 Soft Tissue Defects: Interim Results from the Prospective Multicenter MASTRR Registry
Tracee Short, John Lawlor, Patrick Martyka, Joshua H. Wolf, Jessica M. Felton, Alison A. Smith, Yosef Y. Nasseri, Moshe Barnajian, W. Matthew Vassy, Michael Cormican, Pranat Kumar, John J. Choi, Lung Lau, John H. Loftus, Nicole P. Bernal, Christopher A. B
Advances in Therapy.2026;[Epub] CrossRef

Venous phase extravasation on computed tomography is a red flag sign in critical/severe pelvic injuries: Hong Kyung Shin, Chami Im, Hye Rim Shin, Mi Jeong Choi, Jung-Woo Woo; J Trauma Inj. 2025;38(4):360-365. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0198

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Abstract PDF: Purpose
Managing hemodynamically unstable patients with pelvic fractures is highly challenging, particularly when vascular injuries are present, as these can significantly worsen prognosis. This study evaluated outcomes in patients with pelvic trauma and vascular injuries prior to the introduction of preperitoneal pelvic packing.
Methods
We retrospectively reviewed the medical records of 195 patients with pelvic injuries who presented to the emergency room of our hospital between May 2003 and August 2013.
Results
Among the 195 patients, 34 had vascular injuries and 161 had nonvascular injuries. The vascular injury group had significantly higher transfusion rates (82.4% vs. 11.8%, P<0.001) and required a greater mean number of packed red blood cell units than the nonvascular group (5.2±5.5 vs. 0.4±1.4, P<0.001). Subgroup analysis within the vascular injury cohort revealed significant differences between patients with venous phase extravasation (n=5) and those with isolated arterial phase extravasation (n=29) in median packed red blood cell units transfused (12.5 units vs. 3 units; P=0.014), cardiac arrest rate (80.0% vs. 10.3%, P=0.003), and mortality rate (60.0% vs. 10.3%, P=0.029). Notably, patients with isolated venous extravasation showed a significantly higher mortality rate compared to those with isolated arterial extravasation (100% vs. 10.3%, P=0.004).
Conclusions
Venous phase extravasation was associated with higher transfusion requirements, cardiac arrest incidence, and mortality compared to arterial extravasation.; 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

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