Journal of Trauma and Injury

Case Report

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; Received February 28, 2025 Accepted May 2, 2025 Published online November 20, 2025; DOI: https://doi.org/10.20408/jti.2025.0046 [Epub ahead of print]

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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 systolic 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

Original Article

Chest wall injury fracture patterns are associated with different mechanisms of injury: a retrospective review study in the United States: Jennifer M. Brewer, Owen P. Karsmarski, Jeremy Fridling, T. Russell Hill, Chasen J Greig, Sarah Posillico, Carol McGuiness, Erin McLaughlin, Stephanie C. Montgomery, Manuel Moutinho, Ronald Gross, Evert A. Eriksson, Andrew R. Doben; J Trauma Inj. 2024;37(1):48-59. Published online February 23, 2024; DOI: https://doi.org/10.20408/jti.2023.0065

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Purpose
Research on rib fracture management has exponentially increased. Predicting fracture patterns based on the mechanism of injury (MOI) and other possible correlations may improve resource allocation and injury prevention strategies. The Chest Injury International Database (CIID) is the largest prospective repository of the operative and nonoperative management of patients with severe chest wall trauma. The purpose of this study was to determine whether the MOI is associated with the resulting rib fracture patterns. We hypothesized that specific MOIs would be associated with distinct rib fracture patterns.
Methods
The CIID was queried to analyze fracture patterns based on the MOI. Patients were stratified by MOI: falls, motor vehicle collisions (MVCs), motorcycle collisions (MCCs), automobile-pedestrian collisions, and bicycle collisions. Fracture locations, associated injuries, and patient-specific variables were recorded. Heat maps were created to display the fracture incidence by rib location.
Results
The study cohort consisted of 1,121 patients with a median RibScore of 2 (0–3) and 9,353 fractures. The average age was 57±20 years, and 64% of patients were male. By MOI, the number of patients and fractures were as follows: falls (474 patients, 3,360 fractures), MVCs (353 patients, 3,268 fractures), MCCs (165 patients, 1,505 fractures), automobile-pedestrian collisions (70 patients, 713 fractures), and bicycle collisions (59 patients, 507 fractures). The most commonly injured rib was the sixth rib, and the most common fracture location was lateral. Statistically significant differences in the location and patterns of fractures were identified comparing each MOI, except for MCCs versus bicycle collisions.
Conclusions
Different mechanisms of injury result in distinct rib fracture patterns. These different patterns should be considered in the workup and management of patients with thoracic injuries. Given these significant differences, future studies should account for both fracture location and the MOI to better define what populations benefit from surgical versus nonoperative management.

Summary

Citations

Citations to this article as recorded by

Non-Completely Displaced Traumatic Rib Fractures: Potentially Less Crucial for Pulmonary Adverse Outcomes, Regardless of Classification
Hongrye Kim, Su Young Yoon, Jonghee Han, Junepill Seok, Wu Seong Kang
Medicina.2025; 61(1): 81. CrossRef
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K. Mattam, P. Wijerathne, J. N. Rao, S. Tenconi, L. Ventura, J. G. Edwards
European Journal of Trauma and Emergency Surgery.2025;[Epub] CrossRef
Epidemiology of Symptomatic Non-Union/Malunion Rib Fractures
Daniel Akyeampong, Alexander Hoey, Ronald Gross, Evert A. Eriksson
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Artificial intelligence models for predicting pulmonary complications in patients with chest trauma: a retrospective study
Junepill Seok, Jinseok Lee, Wu Seong Kang
Journal of Trauma and Injury.2025; 38(3): 237. CrossRef
Comparison of flail and multiple simple rib fracture patterns among patients included in rib fracture studies; A systematic review and meta-analysis
Maartje L. Luttjeboer, Esther M. M. Van Lieshout, Fredric M. Pieracci, Zachary M. Bauman, Evert A. Eriksson, Joseph D. Forrester, Michael H. J. Verhofstad, Mathieu M. E. Wijffels
European Journal of Trauma and Emergency Surgery.2025;[Epub] CrossRef

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