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

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

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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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

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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

Comparing the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale (GCS) for predicting outcomes in traumatic brain injury: a comparative study: Harsh Jain, Jishnu N. Nair, Davuluri Venkata Shashank, Visvanathan Krishnaswamy, Krishnamurthy Ganesh; J Trauma Inj. 2025;38(4):327-334. Published online December 31, 2025; DOI: https://doi.org/10.20408/jti.2025.0125

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Purpose
Traumatic brain injuries (TBIs) are a leading cause of morbidity, mortality, socioeconomic loss, and diminished quality of life among survivors of all injury types. The Glasgow Coma Scale (GCS), though commonly used in the intensive care unit (ICU), has limitations that may be addressed by the Full Outline of Unresponsiveness (FOUR) score. We compared the ability of the FOUR and GCS scores to predict outcomes in patients with TBI.
Methods
This prospective observational study included all patients presenting with head injury who survived beyond 24 hours between 2020 and 2022. Basic demographic data, prehospital care details, and neurological findings were collected. TBI severity was assessed using both the GCS and FOUR scores, and outcomes were graded using the Glasgow Outcome Score (GOS).
Results
Among 225 patients (mean age, 42.4±19.7 years; male sex, 77.8%) with TBIs, the mortality rate was 4.4%, and 15.1% experienced a poor outcome (GOS ≤2). Receiver operating characteristic curve analysis showed good predictive ability for both the FOUR score (area under the curve [AUC], 0.85) and GCS (AUC, 0.88). FOUR score ≤12 and GCS ≤10 were identified as optimal cutoff values for predicting poor outcomes (P<0.001), with the FOUR score demonstrating sensitivity and specificity of 79.4% and 77.5%, respectively. A FOUR score ≤12 at admission was significantly associated with intubation (odds ratio [OR], 8.2; 95% confidence interval [CI], 4.6–14.4; P<0.001), tracheostomy (OR, 21.8; 95% CI. 6.9–68.8; P<0.001), and neurological complications, including mental function deficits (OR, 7.5; 95% CI, 3.2–17.7; P<0.001), cranial nerve palsy (OR, 4.1; 95% CI, 1.6–10.4; P=0.002), and motor deficits (OR, 9.4; 95% CI, 4.6–19.2; P<0.001). A strong correlation was observed between the FOUR score and GOS (r=0.7).
Conclusions
The FOUR score is a reliable tool for assessing TBI severity and predicting outcomes, with performance comparable to the GCS. An admission FOUR score ≤12 was associated with poor neurological outcomes, increased need for advanced airway management, and long-term disability. By capturing additional neurological parameters beyond the GCS, the FOUR score may offer clinical advantages in ICU settings for early prognostication and management of patients with TBI.

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NEUROLOGICAL AND HEMODYNAMIC PROFILES OF POST CRANIOTOMY PATIENTS BASED ON SURVIVAL STATUS IN THE INTENSIVE CARE UNIT
Rudi Hariyono Hariyono
International Journal of Nursing and Midwifery Sc.2026; 10(2): 341. CrossRef

Use of the Obstetric Early Warning Score in emergency triage for pregnant trauma patients: a retrospective cross-sectional study on a tool for early hospitalization decision-making: Figen Topalak, Selen Acehan, Salim Satar, Muge Gulen, Sarper Sevdimbas, Kadir Nigiz, Mehmet Gorur, Ali İsa Aslan, Ihsan Dengiz; J Trauma Inj. 2026;39(1):25-33. Published online December 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0104

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Abstract PDF: Purpose
Traumatic injuries during pregnancy present significant challenges for emergency providers, necessitating rapid assessment to ensure the safety of both mother and fetus. Scoring systems that can be applied immediately upon presentation may facilitate early triage and inform disposition decisions. This study evaluated the predictive performance of the Obstetric Early Warning Score (OEWS), Injury Severity Score (ISS), and Revised Trauma Score (RTS) in determining hospitalization needs among pregnant trauma patients admitted to the emergency department (ED).
Methods
This retrospective cross-sectional study included pregnant trauma patients aged 18 years or older who were admitted to a tertiary care ED between January 2019 and December 2022. Demographic, clinical, laboratory, and trauma-related data were collected. OEWS, ISS, and RTS were calculated at admission. The primary outcome was the requirement for hospitalization. Binary logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess predictive performance.
Results
A total of 316 pregnant trauma patients were included. Hospitalization was required in 14.9% of cases. Higher OEWS (mean, 2.63 vs. 0.33; P=0.001) and ISS (mean, 18.02 vs. 5.04; P<0.001) were significantly associated with hospitalization. In multivariate analysis, OEWS (odds ratio [OR], 1.553; 95% confidence interval [CI], 1.087–2.219; P=0.016) and ISS (OR, 1.170; 95% CI, 1.083–1.264; P<0.001) were independent predictors of hospitalization. ROC analysis demonstrated that ISS had the highest predictive value (area under the curve, 0.783; 95% CI, 0.695–0.870; P<0.001).
Conclusions
Both ISS and OEWS are effective tools for predicting hospitalization needs in pregnant trauma patients. Incorporating these scoring systems into ED triage protocols may enhance early identification of high-risk patients and improve outcomes for both mothers and fetuses.; Summary

Review Article

Prognostic role of serum interleukin-6 levels in polytrauma patients: a comprehensive narrative review: Nicola Madani, Sereen Halayqeh, Hebah Almahariq, Ahmad Al-Badawi, Mohammad Alomari, Bassem Haddad; J Trauma Inj. 2026;39(1):4-13. Published online December 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0081

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Polytrauma triggers a complex systemic inflammatory response, and early identification of high-risk patients is essential for guiding timely interventions and improving outcomes. Interleukin-6 (IL-6), a rapidly induced proinflammatory cytokine, has emerged as a potential biomarker for prognosis in the trauma setting. This narrative review summarizes current evidence on the prognostic role of IL-6 in polytrauma patients, addressing its biological functions, kinetics after injury, and associations with clinical outcomes such as acute respiratory distress syndrome, multiple organ dysfunction syndrome, intensive care unit admission, and mortality. IL-6 levels have been shown to correlate with injury severity scores and to predict complications more reliably than many other inflammatory markers, largely due to its early elevation and sustained presence in circulation. Furthermore, IL-6 measurement may inform surgical decision-making, particularly in selecting candidates for damage control strategies versus definitive care. Compared to other cytokines and acute-phase reactants, IL-6 demonstrates superior temporal responsiveness and prognostic accuracy in the early postinjury phase. Despite variability in measurement methods and the influence of external confounding factors, IL-6 holds significant promise as a clinical tool for early triage, risk stratification, and potentially therapeutic targeting in trauma care. Standardized protocols and larger multicenter studies are needed to facilitate broader adoption and integration of IL-6 into clinical algorithms.

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The Importance of the “Damage Control” Strategy in Multiple Organ Injuries, Pathophysiology and Principles of Hemorrhage Control
Oliwia Klimek, Jakub Dudek, Anna Czesyk, Bartosz Sierant, Wiktoria Górecka, Grzegorz Gogolewski, Tomasz Jurek, Zuzanna Ochocka, Amelia Jankowska
Journal of Clinical Medicine.2026; 15(7): 2549. CrossRef

Case Reports

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; J Trauma Inj. 2026;39(3):307-311. Published online November 20, 2025; DOI: https://doi.org/10.20408/jti.2025.0052

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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; J Trauma Inj. 2026;39(3):302-306. Published online November 20, 2025; DOI: https://doi.org/10.20408/jti.2025.0046

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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 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; J Trauma Inj. 2026;39(3):312-315. Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0066

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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

Original Article

Comparison of pedestrian injury characteristics between preschoolers and early school-aged children in Korea: a cross-sectional study: Ha Na Jeong, Chan Yong Park; J Trauma Inj. 2025;38(3):211-220. Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0040

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Abstract PDF: Purpose
Pedestrian traffic injuries pose a significant public health issue worldwide and remain prevalent in Korea despite ongoing efforts to improve traffic safety. To inform future initiatives aimed at addressing this problem, this study compared pedestrian injuries between preschoolers (aged 4–5 years) and early school-aged children (aged 6–7 years), using national data on pedestrian injuries in these groups.
Methods
This study analyzed secondary data from the 2020 Community-Based Severe Trauma Surveillance (2016–2020). Injury-related characteristics and outcome variables were compared between the two age groups. Additionally, the distribution of pedestrian injuries was analyzed by month, day, and time.
Results
Of 413 pedestrian injuries, 173 (41.9%) occurred in preschoolers and 240 (58.1%) occurred in early school-aged children. Injuries most frequently occurred in July for preschoolers (18.5%) and in June for early school-aged children (13.3%). Preschoolers experienced more injuries on Saturdays (22.0%), whereas early school-aged children had higher injury rates on Tuesdays and Thursday both (17.9%). Peak injury times were around 5 PM for preschoolers (16.2%) with a secondary peak at 9 AM (15.6%). For early school-aged children, 5 and 6 PM were peak injury times (both 14.6%), with a secondary peak at 3 PM (14.2%). The severe injury group (Injury Severity Score, 16–75) had a significantly higher mortality rate than the mild/moderate injury group (Injury Severity Score, 1–15; odds ratio, 5.65; P=0.006). Furthermore, the mortality rate was significantly higher at local emergency centers than at regional trauma centers (odds ratio, 4.00; P=0.011).
Conclusions
Understanding the distinct characteristics of pedestrian injuries among young children can inform targeted interventions and policies, ultimately mitigating this problem and improving traffic safety for children in Korea and globally.; Summary

Case Report

Inferior vena cava injuries at a level I trauma center: a case series: Rachith Sridhar, Abdul Vakil Khan, Harendra Kumar, Abdul Hakeem, Deepak Kumar, Majid Anwer; J Trauma Inj. 2025;38(3):299-306. Published online June 27, 2025; DOI: https://doi.org/10.20408/jti.2025.0054

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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.

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Visual feedback-based interpretation support for retroperitoneal organ dissection in a VR surgical simulator: a mixed-methods study
Yoshihisa Wada, Kaori Ito, Takahiro Jimbo, Hiroaki Yano
Frontiers in Virtual Reality.2026;[Epub] CrossRef
Sutureless repair of inferior vena cava injury using an elastomeric sealant in a mouse model with histopathological analysis of vascular healing
Yoshinori Nakahara, Shin-ichiro Ohno, Tomohiro Iwakura, Koji Fujita, Shouichirou Mineo, Masahiko Kuroda
JVS-Vascular Science.2026; 7: 100438. CrossRef

Original Article

Lessons from foreign military surgeons in the Korean War: advancing trauma surgery and preparing for future conflicts: Kun Hwang, Chan Yong Park; J Trauma Inj. 2025;38(2):103-110. Published online June 16, 2025; DOI: https://doi.org/10.20408/jti.2025.0041

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Purpose
The Korean War (1950–1953) significantly advanced military medicine, with foreign military surgeons playing a pivotal role in transforming trauma care under extreme conditions.
Methods
Resources such as PubMed, JSTOR, and reports from participating nations formed the basis of this study. A thorough comparative analysis was performed to examine the similarities and differences in medical practices between the United Nations Command and North Korean forces.
Results
The United States introduced Mobile Army Surgical Hospitals, revolutionizing trauma care by enabling rapid intervention near combat zones. Innovations such as helicopter evacuation, whole blood transfusions, and antibiotic treatments reduced mortality rates among treated soldiers to as low as 3%. British surgeons excelled in managing abdominal wounds and performing orthopedic surgery, often undertaking limb-saving procedures. Field hospitals provided comprehensive care for combat injuries and infectious diseases—a major concern given the inadequate sanitation. The Indian 60th Parachute Field Ambulance treated over 20,000 casualties, demonstrating adaptability in harsh environments. The Indian Field Hospital not only treated military casualties but also provided care to Korean civilians, offering life-saving medical interventions under challenging conditions. Denmark deployed the hospital ship MS Jutlandia, equipped with advanced surgical facilities, enabling a level of medical care that was not practical on land. The Swedish Red Cross Field Hospital in Busan delivered crucial medical aid to both military personnel and civilians; its staff focused on civilian outreach and controlling epidemics, with treatments targeting diseases such as typhoid and tuberculosis. Norwegian mobile surgical teams specialized in rapid interventions near combat zones, performing life-saving operations within hours of injury and thus minimizing complications and increasing survival rates.
Conclusions
The lessons learned from these contributions continue to influence modern military and civilian healthcare systems, highlighting the importance of innovation, collaboration, and resilience in conflict settings.

Summary

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Classification of gunshot wounds of the thyroid gland
E.M. Khoroshun, I.A. Lurin, K.V. Misiura, V.V. Makarov, V.V. Nehoduiko, Yu.V. Bunin, B.M. Chernobil, N.Yu. Seliukova
INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine).2025; 21(7): 681. CrossRef

Case Reports

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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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

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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

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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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.

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The Birmingham Eye Trauma Terminology - Extension from Lebanon (BETT-XL) classification: A multi-center validation in modern warfare
Riwa Ibrahim, Oulyana Arafat, Romy Mansour, Ama Sadaka, Faten Al Ghadban, Ahmad Nemer, Souha Allam, Georges El Mollayess, Roland Seif, Hibah Osman, Ghassan Abu-Sittah, Jamal Bleik, Karim Sleiman
Injury.2026; : 113687. CrossRef

Original Article

Injuries from blank cartridge shots in suicide attempts within the South Korean military: a case series of five patients: Jeong Il Joo, Changsin Lee, Kyungwon Lee; J Trauma Inj. 2024;37(4):262-267. Published online December 4, 2024; DOI: https://doi.org/10.20408/jti.2024.0037

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Purpose
Blank cartridges are designed to produce the sound and gas flare of a gunshot without firing a bullet. However, blank cartridge shots (BCS) can still cause injuries ranging from minor to life-threatening. Within the South Korean military, most BCS-related injuries have occurred during suicide attempts. This study documents a case series of patients who sustained injuries from BCS during such attempts.
Methods
We examined the medical records of Korean soldiers at a military trauma center between April 2022 and April 2024 who had sustained injuries from BCS during suicide attempts. The analyzed data included general characteristics, injury site, surgical and psychiatric interventions, and length of hospitalization.
Results
The case series included five patients between 19 and 20 years old (mean age, 19.6±0.55 years). Four of these patients sustained self-inflicted gunshot wounds to the submandibular area, while one targeted the right temporal area. Although initial vital signs and laboratory findings were unremarkable, computed tomography scans revealed injuries from projectile gas and gunpowder, including burns, subcutaneous emphysema, and major structural damage. Cases 1 and 2 required emergency surgery for foreign body removal and debridement. The average length of hospitalization was 35.2±12.11 days. Patients were first admitted to the trauma surgery department for BCS injury management, and then transferred to the psychiatry department for emotional support. The average stay was 15.6±15.87 days in trauma surgery and 19.6±14.99 days in psychiatry.
Conclusions
This study highlights the consequences of BCS from suicide attempts in the South Korean military and provides valuable insights for medical personnel who may encounter patients with BCS injuries.

Summary

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Penetrating chest injury caused by a rubber bullet in a Republic of Korea Army soldier: a case report
Chansin Lee, Kyungwon Lee
Journal of Acute Care Surgery.2025; 15(3): 164. CrossRef

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