Journal of Trauma and Injury

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 Reports

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

Subclavian artery pseudoaneurysm treated with surgery following endovascular balloon occlusion: a case report: Jaeik Jang, Jayun Cho; J Trauma Inj. 2025;38(4):389-393. Published online December 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0078

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Abstract PDF: Subclavian vessel injury concomitant with a closed clavicle fracture is rare, and challenges associated with exposure often make proximal control difficult. This paper presents the case of a 26-year-old man who presented to the emergency department after a fall from the sixth floor with multiple injuries, including closed clavicle fractures and a subclavian artery pseudoaneurysm. Proximal control was achieved with endovascular balloon occlusion rather than by performing cervical extension of median sternotomy. Subsequently, exposure was obtained through a subclavian incision, and the injury was treated with a bypass graft.; Summary

Isolated orbital roof fracture with concurrent orbital compartment syndrome: a case report: Khalifa Al Alawi, Sondus Al Jadeedi, Sultan Al Shaqsi, Meera Sahib, Taimoor Al Balushi; Received March 24, 2025 Accepted August 17, 2025 Published online December 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0070 [Epub ahead of print]

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Abstract PDF: Isolated orbital roof fractures are rare, accounting for less than 0.2% of all facial fractures. They usually result from high-velocity impacts and are frequently associated with additional facial, ocular, and neurological trauma, necessitating a multidisciplinary team approach. In this report, we present a case of an isolated orbital roof fracture complicated by orbital compartment syndrome, severe proptosis, vision loss, corneal abrasion, subdural hemorrhage, and a dural tear. Surgical intervention was initially delayed due to logistical constraints. Ultimately, fracture reduction and orbital roof reconstruction were successfully performed using a split calvarial bone graft. Postoperatively, there was marked improvement in proptosis and visual function; however, the patient continued to experience residual visual impairment due to corneal laceration. Although less common, orbital roof fractures represent a potentially serious form of craniofacial trauma. Standardized treatment protocols remain difficult to establish, given the rarity of such injuries. Repair methods are primarily directed at separating intracranial from intraorbital contents. A coordinated interdisciplinary approach involving plastic surgery, ophthalmology, and neurosurgery is essential for comprehensive patient management.; Summary

Original Articles

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

Is dorsal cortex drilling necessary for distal radius fractures treated with a volar locking plate? A comparative study of near-cortex-only and far-cortex drilling: Chul Hong Kim, Sung Yoon Jung, Hyeon Jun Kim, Si-Hyun Park; J Trauma Inj. 2025;38(3):248-254. Published online September 29, 2025; DOI: https://doi.org/10.20408/jti.2025.0018

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Abstract PDF: Purpose
This study aimed to compare and analyze the effectiveness of near-cortex-only drilling for the surgical treatment of distal radius fractures using a volar locking plate.
Methods
From January 2010 to December 2022, a total of 185 patients aged 60 years or older with AO type C distal radius fractures who were treated with a volar locking plate at our hospital were enrolled. Of these, 59 patients were excluded according to the study criteria, resulting in a final cohort of 126 subjects. Without differentiating between left and right sides, group A (n=60) underwent distal locking screw fixation with screws of 12-mm length (except for the most radial screw) using near-cortex-only drilling. In group B (n=66), drilling was performed through to the dorsal cortex, and the length was measured using a depth gauge; distal screws were then fixed at a length 2 mm shorter than the measured depth. The degree of fracture reduction on postoperative radiographs was assessed using the modified Lidstrom scoring system by measuring radial inclination, radial height, and volar tilt. In addition, the visual analog scale, the Korean Disabilities of the Arm, Shoulder, and Hand (DASH) score, and the incidence of extensor tendon rupture and tenosynovitis were evaluated at the final follow-up and compared between groups.
Results
Bone union was achieved in all cases, with no significant radiographic differences observed between the two groups (P>0.05). In contrast, two cases of extensor tenosynovitis were noted in group A, whereas group B experienced one extensor tendon rupture and five cases of extensor tenosynovitis, representing a significant difference (P<0.05).
Conclusions
In patients aged 60 years or older with AO type C distal radius fractures, the technique of near-cortex-only drilling with short distal locking screws yielded satisfactory results for fracture reduction and clinical indices. This approach may offer a new alternative for preventing extensor tendon rupture or tenosynovitis.; 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; Received January 31, 2025 Accepted April 7, 2025 Published online September 3, 2025; DOI: https://doi.org/10.20408/jti.2025.0025 [Epub ahead of print]

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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

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

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
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.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

Preperitoneal pelvic packing as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability after the Kocher-Langenbeck approach to the acetabulum: a case report: Doo-Hun Kim, Maru Kim, Dae-Sang Lee, Tae Hwa Hong, Hangjoo Cho; J Trauma Inj. 2025;38(3):285-289. Published online June 25, 2025; DOI: https://doi.org/10.20408/jti.2024.0087

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Abstract PDF: Pelvic fractures result from high-energy trauma, and when accompanied by hemorrhagic shock, the mortality rate increases to 40%. Pelvic fractures are anatomically categorized as pelvic ring disruptions and acetabular fractures, each requiring different treatment methods and approaches. Acetabular fractures, which also result from high-energy injuries, may be accompanied by hemorrhagic shock. Treatment options for pelvic fractures with hemorrhagic shock include angioembolization, preperitoneal pelvic packing (PPP), and emergency laparotomy. In hemodynamically stable patients, early total care may be attempted, and for acetabular fractures (posterior column), the Kocher-Langenbeck approach is the treatment of choice. This case report describes the use of PPP as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability following a Kocher-Langenbeck approach for an acetabular fracture with pelvic ring injury. The patient was discharged without postoperative complications such as bone displacement or surgical site infection. While PPP is commonly employed as an initial treatment modality for pelvic fractures with hemorrhagic shock, it may also be valuable in managing postoperative retroperitoneal bleeding with hemorrhagic shock.; 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

Relevance of the Watson-Jones anterolateral approach in the management of Pipkin type II fracture-dislocation: a case report and literature review: Nazim Sifi, Ryad Bouguenna; J Trauma Inj. 2024;37(2):161-165. Published online June 17, 2024; DOI: https://doi.org/10.20408/jti.2024.0004

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Abstract PDF

Femoral head fractures with associated hip dislocations substantially impact the functional prognosis of the hip joint and present a surgical challenge. The surgeon must select a safe approach that enables osteosynthesis of the fracture while also preserving the vascularization of the femoral head. The optimal surgical approach for these injuries remains a topic of debate. A 44-year-old woman was involved in a road traffic accident, which resulted in a posterior iliac dislocation of the hip associated with a Pipkin type II fracture of the femoral head. Given the size of the detached fragment and the risk of incarceration preventing reduction, we opted against attempting external orthopedic reduction maneuvers. Instead, we chose to perform open reduction and internal fixation using the Watson-Jones anterolateral approach. This involved navigating between the retracted tensor fascia lata muscle, positioned medially, and the gluteus medius and minimus muscles, situated laterally. During radiological and clinical follow-up visits extending to postoperative month 15, the patient showed no signs of avascular necrosis of the femoral head, progression toward coxarthrosis, or heterotopic ossification. The Watson-Jones anterolateral approach is a straightforward intermuscular and internervous surgical procedure. This method provides excellent exposure of the femoral head, preserves its primary vascularization, allows for anterior dislocation, and facilitates the anatomical reduction and fixation of the fracture.

Summary

Citations

Citations to this article as recorded by

Pipkin fractures: fracture type-specific management
Axel Gänsslen, Richard A. Lindtner, Dietmar Krappinger, Jochen Franke
Archives of Orthopaedic and Trauma Surgery.2024; 144(10): 4601. CrossRef

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