Journal of Trauma and Injury

Articles in E-pub version are posted online ahead of regular printed publication.

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; Received October 23, 2024 Accepted February 6, 2025 Published online April 21, 2025; DOI: https://doi.org/10.20408/jti.2024.0072 [Epub ahead of print]

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

Traumatic globe avulsion secondary to a penetrating orbital injury from a bicycle handlebar: a case report: Nishanth S. Iyengar, Edward Xie, Patricia Pahk, Nariman S. Boyle; Received October 23, 2024 Accepted January 5, 2025 Published online April 1, 2025; DOI: https://doi.org/10.20408/jti.2024.0070 [Epub ahead of print]

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

Resolution is not the end: The Macklin effect after chest tube removal in a trauma patient with aging and comorbidities: a case report: Faye Abdulkareem, Fayez G. Aldarsouni, Sahar Alomar, Zisis Touloumis, Hussain M. AlHassan, Ghassan Z. Al Ramahi, Tareq Alsabahi, Khaled Twier, Mohammad Alsenani, Emad Alamoudi; Received December 1, 2024 Accepted January 12, 2025 Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0090 [Epub ahead of print]

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Abstract PDF: Pneumomediastinum is an uncommon complication in cases of blunt chest trauma but can signal severe underlying issues. This report discusses a 69-year-old male patient with preexisting conditions of obesity, sleep apnea, and asthma, who experienced delayed pneumomediastinum and pneumopericardium following the removal of a chest tube. This tube had been placed to address a traumatic hemopneumothorax, which had resolved. The removal of the chest tube triggered a series of events, exacerbated by the patient's chronic health conditions. The patient was managed conservatively with close monitoring and physiotherapy, which successfully resolved the condition without the need for further invasive procedures. The multifactorial nature of the Macklin effect illustrates that even routine procedures such as chest tube removal can trigger a chain reaction in susceptible patients. The choice of conservative management, rather than immediate invasive interventions, underscores the delicate balance necessary in trauma care.; Summary

Successful laparotomy for intra-abdominal hypertension following veno-venous extracorporeal membrane oxygenation after severe thoracoabdominal trauma: a case report: Yo Huh, Jonghwan Moon, Kyoungwon Jung, Hye-Min Sohn; Received September 21, 2024 Accepted December 31, 2024 Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0060 [Epub ahead of print]

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

Cerebral fat emboli monitoring using transcranial Doppler ultrasound and confirmation of a successful treatment response: a case report: Morgan Jude, Ryan Martin, Ivy Nguyen, Christine Cocanour, Heather Nicoletto, Keyanna Raihani, Alicia Alley, Jeffrey R. Vitt; Received October 25, 2024 Accepted January 5, 2025 Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0075 [Epub ahead of print]

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

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

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

Similarities and differences between lightning and electrical injuries: two case reports: Yi Liu, Zosimo Ken L. Jimeno, Wan Azman Wan Sulaiman; Received October 18, 2024 Accepted December 23, 2024 Published online March 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0067 [Epub ahead of print]

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

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