Pub Date : 2025-11-17DOI: 10.1016/j.tcr.2025.101276
Muzna Al Sawafi, Sachin Potdar
Background
Focused Assessment with Sonography for Trauma (FAST) is a cornerstone in the early assessment of trauma patients. However, a negative initial FAST does not always rule out intra-abdominal injury.
Case presentation
A middle-aged male presented to the ED following a motor vehicle collision. Both FAST and CT scans were initially negative for significant intra-abdominal injury. He was clinically stable and prepared for transfer to a trauma center. Repeat assessment due to subtle hypotension revealed free fluid on a repeat FAST. Emergent laparotomy identified a mesenteric tear with ischemic bowel, requiring resection.
Conclusion
This case illustrates the diagnostic limitations of a single FAST scan. Serial FAST examinations can reveal evolving injuries and should be considered in trauma protocols, especially in patients with changing clinical status.
{"title":"Serial FAST scans reveal delayed mesenteric injury in a polytrauma patient: A case report","authors":"Muzna Al Sawafi, Sachin Potdar","doi":"10.1016/j.tcr.2025.101276","DOIUrl":"10.1016/j.tcr.2025.101276","url":null,"abstract":"<div><h3>Background</h3><div>Focused Assessment with Sonography for Trauma (FAST) is a cornerstone in the early assessment of trauma patients. However, a negative initial FAST does not always rule out intra-abdominal injury.</div></div><div><h3>Case presentation</h3><div>A middle-aged male presented to the ED following a motor vehicle collision. Both FAST and CT scans were initially negative for significant intra-abdominal injury. He was clinically stable and prepared for transfer to a trauma center. Repeat assessment due to subtle hypotension revealed free fluid on a repeat FAST. Emergent laparotomy identified a mesenteric tear with ischemic bowel, requiring resection.</div></div><div><h3>Conclusion</h3><div>This case illustrates the diagnostic limitations of a single FAST scan. Serial FAST examinations can reveal evolving injuries and should be considered in trauma protocols, especially in patients with changing clinical status.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101276"},"PeriodicalIF":0.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fractures of the distal third of the radius often involve instability of the distal radioulnar and secondary stabilizers. In some cases, reduction of the distal radioulnar is prevented by the interposition of other dislocated structures. Dislocation and interposition of the deep flexor of the fifth finger is rarely observed in this type of fracture.
The authors present a review of the literature and the case of a 36-year-old female athlete who presented to the emergency room after a trauma to the wrist, during a barbell exercise. A first radiographic examination showed a fracture of the distal third of the radius and clinically she presented with an apparent deficit in extension of the fourth and fifth fingers. An initial ultrasound examination, performed in the emergency room, did not show any lesions affecting the ulnar nerve. Following an initial reduction and osteosynthesis of the fracture, in which no instability of the distal radioulnar joint or lesions affecting the ulnar nerve were observed, the patient continued to show an apparent deficit in extension of the IV and V fingers. The patient underwent an orthopaedic and radiological re-evaluation, where a dorsal dislocation of the deep flexor of the V finger was highlighted. This article describes the management and treatment of a rare case of dorsal dislocation of the deep flexor of the V finger following a fracture of the distal third of the radius.
{"title":"A rare presentation of a complex Galeazzi fracture-dislocation and a review of literature on complications: dislocation and interposition of the deep flexor of the fifth finger","authors":"Stefania Briano , Federico Vitali , Giacomo Demontis , Emanuela Dapelo , Alessandra Galuppi , Giulia Pachera , Vittoria Mazzola , Matteo Formica","doi":"10.1016/j.tcr.2025.101277","DOIUrl":"10.1016/j.tcr.2025.101277","url":null,"abstract":"<div><div>Fractures of the distal third of the radius often involve instability of the distal radioulnar and secondary stabilizers. In some cases, reduction of the distal radioulnar is prevented by the interposition of other dislocated structures. Dislocation and interposition of the deep flexor of the fifth finger is rarely observed in this type of fracture.</div><div>The authors present a review of the literature and the case of a 36-year-old female athlete who presented to the emergency room after a trauma to the wrist, during a barbell exercise. A first radiographic examination showed a fracture of the distal third of the radius and clinically she presented with an apparent deficit in extension of the fourth and fifth fingers. An initial ultrasound examination, performed in the emergency room, did not show any lesions affecting the ulnar nerve. Following an initial reduction and osteosynthesis of the fracture, in which no instability of the distal radioulnar joint or lesions affecting the ulnar nerve were observed, the patient continued to show an apparent deficit in extension of the IV and V fingers. The patient underwent an orthopaedic and radiological re-evaluation, where a dorsal dislocation of the deep flexor of the V finger was highlighted. This article describes the management and treatment of a rare case of dorsal dislocation of the deep flexor of the V finger following a fracture of the distal third of the radius.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101277"},"PeriodicalIF":0.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Quadriceps tendon (QT) rupture is a rare clinical condition often caused by direct trauma in healthy individuals. Although several repair techniques for QT rupture (QTR) have been proposed, there is no consensus on the best repair technique. We report on a 55-year-old man who suffered a right QTR caused by a fall down stairs. Reconstruction of the QT was performed using a suspensory fixation device with doubled hamstring autograft and Internal Brace. At 6 months follow-up, the patient maintained excellent function. This technique may be an effective method of repairing ruptured QT.
{"title":"Reconstruction of a quadriceps tendon rupture using a suspensory fixation device with doubled hamstring autograft and internal brace; a case report","authors":"Tsuneari Takahashi , Takuya Shiraishi , Katsushi Takeshita","doi":"10.1016/j.tcr.2025.101287","DOIUrl":"10.1016/j.tcr.2025.101287","url":null,"abstract":"<div><div>Quadriceps tendon (QT) rupture is a rare clinical condition often caused by direct trauma in healthy individuals. Although several repair techniques for QT rupture (QTR) have been proposed, there is no consensus on the best repair technique. We report on a 55-year-old man who suffered a right QTR caused by a fall down stairs. Reconstruction of the QT was performed using a suspensory fixation device with doubled hamstring autograft and Internal Brace. At 6 months follow-up, the patient maintained excellent function. This technique may be an effective method of repairing ruptured QT.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101287"},"PeriodicalIF":0.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A malunited proximal humerus fracture treated unconventionally, not in line with the literature recommendations, achieved excellent functional results at 6 months of follow-up.
Case presentation
A 14 year-old boy presented with an inability to raise his right arm above shoulder level and a deformity in the right shoulder. Following the X-ray and further investigations, the fracture shows angulation and displacement beyond the acceptable criteria. After consideration of the patient's demands, analysis of the difficulties faced by the patient, and consideration of the surgical challenges, it was decided not to treat with Open Reduction Internal Fixation.
Conclusion
Despite the treatment not aligning with literature recommendations, the patient was able to achieve an excellent functional result. This malunited proximal humerus case highlights the importance of individualizing treatment for each patient and emphasizes the concept of ‘less is more’ in medicine.
{"title":"Management of Malunited Paeditric Surgical Neck Humerus Fracture proves the phrase “Less is More”","authors":"Ravi Kumar , Anita Saran , Akshat Gupta , Abhishek Kumar Mishra , Prateek Sihag","doi":"10.1016/j.tcr.2025.101284","DOIUrl":"10.1016/j.tcr.2025.101284","url":null,"abstract":"<div><h3>Background</h3><div>A malunited proximal humerus fracture treated unconventionally, not in line with the literature recommendations, achieved excellent functional results at 6 months of follow-up.</div></div><div><h3>Case presentation</h3><div>A 14 year-old boy presented with an inability to raise his right arm above shoulder level and a deformity in the right shoulder. Following the X-ray and further investigations, the fracture shows angulation and displacement beyond the acceptable criteria. After consideration of the patient's demands, analysis of the difficulties faced by the patient, and consideration of the surgical challenges, it was decided not to treat with Open Reduction Internal Fixation.</div></div><div><h3>Conclusion</h3><div>Despite the treatment not aligning with literature recommendations, the patient was able to achieve an excellent functional result. This malunited proximal humerus case highlights the importance of individualizing treatment for each patient and emphasizes the concept of ‘less is more’ in medicine.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101284"},"PeriodicalIF":0.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1016/j.tcr.2025.101285
Luca H. Plekkenpol , Judith Olde Heuvel , A. Sybrand Homan , Roy B.G. Brokelman , Bas L. Fransen
Aims
Subtrochanteric periprosthetic femoral fractures (PPFF) in elderly patients with metal-on-metal hip resurfacing implants are rare and pose significant management challenges. This case report describes the surgical management of such a fracture and provides a review of reported treatment strategies.
Methods
A 79-year-old woman with a sixteen-year-old Birmingham Hip Resurfacing (BHR) prosthesis sustained a comminuted subtrochanteric femoral fracture following a fall. The fracture was treated with open reduction and internal fixation (ORIF) using a Locking Compression Plate and cerclage wires. A literature review was conducted to evaluate surgical approaches and outcomes for similar cases.
Results
Postoperatively, the patient mobilized with weight-bearing restrictions and showed satisfactory fracture healing at follow-up, with radiographic consolidation at four months and full functional recovery. The literature review showed that ORIF, primarily using plate osteosynthesis, is the preferred treatment for subtrochanteric PPFFs in resurfacing arthroplasty, yielding good fracture consolidation and mobility outcomes. Total hip arthroplasty (THA) is typically reserved for fractures with implant loosening or insufficient bone quality.
Conclusion
ORIF is an effective treatment for subtrochanteric PPFF in elderly patients with stable resurfacing implants, promoting fracture healing and functional restoration. This case underscores the complexity of managing such fractures in aging populations and emphasizes the need for individualized treatment plans. Given the aging population with resurfacing prostheses, further research is needed to optimize treatment strategies and improve patient outcomes.
{"title":"Subtrochanteric periprosthetic femoral fracture with a resurfacing metal-on-metal prosthesis in situ in an elderly patient: An increasing problem? – A case report and literature review","authors":"Luca H. Plekkenpol , Judith Olde Heuvel , A. Sybrand Homan , Roy B.G. Brokelman , Bas L. Fransen","doi":"10.1016/j.tcr.2025.101285","DOIUrl":"10.1016/j.tcr.2025.101285","url":null,"abstract":"<div><h3>Aims</h3><div>Subtrochanteric periprosthetic femoral fractures (PPFF) in elderly patients with metal-on-metal hip resurfacing implants are rare and pose significant management challenges. This case report describes the surgical management of such a fracture and provides a review of reported treatment strategies.</div></div><div><h3>Methods</h3><div>A 79-year-old woman with a sixteen-year-old Birmingham Hip Resurfacing (BHR) prosthesis sustained a comminuted subtrochanteric femoral fracture following a fall. The fracture was treated with open reduction and internal fixation (ORIF) using a Locking Compression Plate and cerclage wires. A literature review was conducted to evaluate surgical approaches and outcomes for similar cases.</div></div><div><h3>Results</h3><div>Postoperatively, the patient mobilized with weight-bearing restrictions and showed satisfactory fracture healing at follow-up, with radiographic consolidation at four months and full functional recovery. The literature review showed that ORIF, primarily using plate osteosynthesis, is the preferred treatment for subtrochanteric PPFFs in resurfacing arthroplasty, yielding good fracture consolidation and mobility outcomes. Total hip arthroplasty (THA) is typically reserved for fractures with implant loosening or insufficient bone quality.</div></div><div><h3>Conclusion</h3><div>ORIF is an effective treatment for subtrochanteric PPFF in elderly patients with stable resurfacing implants, promoting fracture healing and functional restoration. This case underscores the complexity of managing such fractures in aging populations and emphasizes the need for individualized treatment plans. Given the aging population with resurfacing prostheses, further research is needed to optimize treatment strategies and improve patient outcomes.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101285"},"PeriodicalIF":0.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1016/j.tcr.2025.101289
Darshan Kumar A. Jain , Harshit Bhaskar Shetty
Lateral elbow painful snapping is a rare, debilitating condition, often misdiagnosed for lateral epicondylitis due to its unfamiliarity or lack of definitive imaging tool to diagnose it. We report a case of a 25-year-old male with a 4-month history of painful snapping during terminal elbow flexion, triggered by weightlifting and push-ups, without prior trauma. Clinical examination showed bilateral elbow hyperextension of 10°, with visible/palpable snapping and pain at 110°-120° flexion, occurring in both supinated and pronated forearm positions, only when initiated from full extension. MRI revealed a small triangular soft tissue fold with effusion in the radio-capitellar joint. Arthroscopy identified a thick, whitish, continuous band of soft tissue spanning the radio-capitellar joint from anterior to posterior, with a free inner end and lateral capsular attachment. Cartilage erosions were noted on the proximal and outer radial head (contiguous portion). Arthroscopic resection of the interposing tissue resolved symptoms immediately post-operatively. Histopathology confirmed features consistent with a synovial plica. Literature suggests that the dynamic nature of this condition and clinicians' unfamiliarity often lead to missed diagnoses on plain MRI. Unlike the commonly reported posterolateral plica, this case involved a rare continuous band causing snapping in both pronated and supinated positions. This report underscores the importance of recognizing atypical presentations of lateral elbow snapping and highlights the efficacy of early arthroscopic excision for symptom relief and cartilage preservation, offering a valuable diagnostic and therapeutic approach for this rare condition.
{"title":"Lateral elbow painful snap secondary to a continuous plica synovialis in the radiocapitellar joint: Case report","authors":"Darshan Kumar A. Jain , Harshit Bhaskar Shetty","doi":"10.1016/j.tcr.2025.101289","DOIUrl":"10.1016/j.tcr.2025.101289","url":null,"abstract":"<div><div>Lateral elbow painful snapping is a rare, debilitating condition, often misdiagnosed for lateral epicondylitis due to its unfamiliarity or lack of definitive imaging tool to diagnose it. We report a case of a 25-year-old male with a 4-month history of painful snapping during terminal elbow flexion, triggered by weightlifting and push-ups, without prior trauma. Clinical examination showed bilateral elbow hyperextension of 10°, with visible/palpable snapping and pain at 110°-120° flexion, occurring in both supinated and pronated forearm positions, only when initiated from full extension. MRI revealed a small triangular soft tissue fold with effusion in the radio-capitellar joint. Arthroscopy identified a thick, whitish, continuous band of soft tissue spanning the radio-capitellar joint from anterior to posterior, with a free inner end and lateral capsular attachment. Cartilage erosions were noted on the proximal and outer radial head (contiguous portion). Arthroscopic resection of the interposing tissue resolved symptoms immediately post-operatively. Histopathology confirmed features consistent with a synovial plica. Literature suggests that the dynamic nature of this condition and clinicians' unfamiliarity often lead to missed diagnoses on plain MRI. Unlike the commonly reported posterolateral plica, this case involved a rare continuous band causing snapping in both pronated and supinated positions. This report underscores the importance of recognizing atypical presentations of lateral elbow snapping and highlights the efficacy of early arthroscopic excision for symptom relief and cartilage preservation, offering a valuable diagnostic and therapeutic approach for this rare condition.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101289"},"PeriodicalIF":0.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Delayed hemothorax, although infrequent, constitutes a life-threatening complication in the context of blunt thoracic trauma. The temporal dissociation between injury and symptom escalation challenges early detection, and the pathophysiological mechanisms often remain elusive. We present a case of an 18-year-old female who developed massive right-sided hemothorax six days after initial injury, necessitating emergent thoracotomy.
Case presentation
The patient, a victim of a high-energy vehicular collision, presented with multiple rib fractures, bilateral pneumothorax, and vertebral injuries. Following initial stabilization and ICU care, she showed promising neurological recovery. However, on the sixth post-injury day, she experienced sudden cardiovascular collapse, and imaging revealed a large hemothorax. Thoracotomy evacuated approximately 2000 mL of blood. No active bleeding source was found. Postoperatively, the patient faced sepsis, air leak complications, and required tracheostomy. She gradually recovered and was discharged in stable condition.
Conclusion
This case highlights the unpredictable nature of delayed hemothorax and underscores the need for vigilance, especially in patients with displaced rib fractures and concomitant pulmonary or vertebral injuries. Serial imaging, multidisciplinary monitoring, and preparedness for surgical intervention are key to improving outcomes in such scenarios.
{"title":"Delayed life-threatening hemothorax following blunt thoracic trauma: A rare and catastrophic evolution in a polytrauma patient","authors":"Shirish Kumar , Milandeep Kaur , Amritanshu Saurabh , Niraj Kumar Srivastava , Pranabh Kushwaha","doi":"10.1016/j.tcr.2025.101290","DOIUrl":"10.1016/j.tcr.2025.101290","url":null,"abstract":"<div><h3>Background</h3><div>Delayed hemothorax, although infrequent, constitutes a life-threatening complication in the context of blunt thoracic trauma. The temporal dissociation between injury and symptom escalation challenges early detection, and the pathophysiological mechanisms often remain elusive. We present a case of an 18-year-old female who developed massive right-sided hemothorax six days after initial injury, necessitating emergent thoracotomy.</div></div><div><h3>Case presentation</h3><div>The patient, a victim of a high-energy vehicular collision, presented with multiple rib fractures, bilateral pneumothorax, and vertebral injuries. Following initial stabilization and ICU care, she showed promising neurological recovery. However, on the sixth post-injury day, she experienced sudden cardiovascular collapse, and imaging revealed a large hemothorax. Thoracotomy evacuated approximately 2000 mL of blood. No active bleeding source was found. Postoperatively, the patient faced sepsis, air leak complications, and required tracheostomy. She gradually recovered and was discharged in stable condition.</div></div><div><h3>Conclusion</h3><div>This case highlights the unpredictable nature of delayed hemothorax and underscores the need for vigilance, especially in patients with displaced rib fractures and concomitant pulmonary or vertebral injuries. Serial imaging, multidisciplinary monitoring, and preparedness for surgical intervention are key to improving outcomes in such scenarios.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101290"},"PeriodicalIF":0.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145575988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report a case of a 44-year-old female with intrathoracic displacement of the humeral head, which was not only missed by the initial trauma team while receiving the patient but also missed by multiple senior surgeons during primary management in the operating room.
Conclusion
Diagnostic accuracy hinges on clinical presentation and detailed imaging locating fragments of the fractured head. Interdisciplinary collaboration, particularly with thoracic and trauma surgeons, is crucial for early diagnosis and timely recovery. The possibility of intrathoracic dislodged head should not be ruled out in proximal humeral fractures irrespective of pulmonary complaints or velocity of trauma.
{"title":"Missed intrathoracically displaced humeral head in proximal humerus fracture dislocation: A case report","authors":"Abhishek Choudhary , Mehar Dhillon , Sameer Aggarwal , Tsering Sangdup , Prasoon Kumar , Sandeep Patel","doi":"10.1016/j.tcr.2025.101278","DOIUrl":"10.1016/j.tcr.2025.101278","url":null,"abstract":"<div><h3>Case</h3><div>We report a case of a 44-year-old female with intrathoracic displacement of the humeral head, which was not only missed by the initial trauma team while receiving the patient but also missed by multiple senior surgeons during primary management in the operating room.</div></div><div><h3>Conclusion</h3><div>Diagnostic accuracy hinges on clinical presentation and detailed imaging locating fragments of the fractured head. Interdisciplinary collaboration, particularly with thoracic and trauma surgeons, is crucial for early diagnosis and timely recovery. The possibility of intrathoracic dislodged head should not be ruled out in proximal humeral fractures irrespective of pulmonary complaints or velocity of trauma.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101278"},"PeriodicalIF":0.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-17DOI: 10.1016/j.tcr.2025.101286
Matthew B. Goss, Joseph S. Banton, Martha M.O. McGilvray, Stephanie M. Armocida, Arvind Kumar, Douglas J.E. Schuerer, Matthew J. McHale
Background
An exceptional occurrence, clinically-significant splenic injury secondary to extracorporeal shock wave lithotripsy (ESWL) is limited to 13 published reports since 1980.
Case Report
62-year-old female underwent ESWL targeting 5 mm ureteral stone at proximal left ureter. Following same-day discharge, medication-refractory abdominal pain precipitated emergency room visit where hypotensive with concern for acute abdomen. Of note, patient denied recent trauma to abdominal region. Imaging revealed acute splenic subcapsular hematoma and hemoperitoneum. Transferred to our institution for higher level of care. Hemodynamic instability with ongoing transfusion requirements and diffuse peritonitis dictated emergent procession to operating room, foregoing consideration of splenic artery embolization.
Conclusions
Splenic injury is an exceedingly rare, potentially life-threatening complication of ESWL. We feature the 4th report since 2020 and 14th overall since practice inception in 1980. Despite the resources of a large level 1 trauma center, our case highlights non-operative management may not be pragmatic in the emergent circumstance. Patient and provider education and early recognition remain key to optimize outcomes.
{"title":"Lithotripsy-induced splenic injury requiring emergent splenectomy at a level 1 trauma center","authors":"Matthew B. Goss, Joseph S. Banton, Martha M.O. McGilvray, Stephanie M. Armocida, Arvind Kumar, Douglas J.E. Schuerer, Matthew J. McHale","doi":"10.1016/j.tcr.2025.101286","DOIUrl":"10.1016/j.tcr.2025.101286","url":null,"abstract":"<div><h3>Background</h3><div>An exceptional occurrence, clinically-significant splenic injury secondary to extracorporeal shock wave lithotripsy (ESWL) is limited to 13 published reports since 1980.</div></div><div><h3>Case Report</h3><div>62-year-old female underwent ESWL targeting 5 mm ureteral stone at proximal left ureter. Following same-day discharge, medication-refractory abdominal pain precipitated emergency room visit where hypotensive with concern for acute abdomen. Of note, patient denied recent trauma to abdominal region. Imaging revealed acute splenic subcapsular hematoma and hemoperitoneum. Transferred to our institution for higher level of care. Hemodynamic instability with ongoing transfusion requirements and diffuse peritonitis dictated emergent procession to operating room, foregoing consideration of splenic artery embolization.</div></div><div><h3>Conclusions</h3><div>Splenic injury is an exceedingly rare, potentially life-threatening complication of ESWL. We feature the 4th report since 2020 and 14th overall since practice inception in 1980. Despite the resources of a large level 1 trauma center, our case highlights non-operative management may not be pragmatic in the emergent circumstance. Patient and provider education and early recognition remain key to optimize outcomes.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101286"},"PeriodicalIF":0.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-16DOI: 10.1016/j.tcr.2025.101272
Stanford Schor , William Knight IV
Traumatic injuries and procedures under anesthesia can both predispose patients to altered mental status for many reasons. In this case, a 21 year old man presented with an isolated femur fracture and developed paroxysmal sympathetic hyperactivity after surgical fixation. This case highlights the diagnostic considerations when a trauma patient develops dysautonomia and altered mental status and explores therapeutic options for treating a patient with sympathetic storming.
{"title":"Cerebral fat embolism presenting as paroxysmal sympathetic hyperactivity","authors":"Stanford Schor , William Knight IV","doi":"10.1016/j.tcr.2025.101272","DOIUrl":"10.1016/j.tcr.2025.101272","url":null,"abstract":"<div><div>Traumatic injuries and procedures under anesthesia can both predispose patients to altered mental status for many reasons. In this case, a 21 year old man presented with an isolated femur fracture and developed paroxysmal sympathetic hyperactivity after surgical fixation. This case highlights the diagnostic considerations when a trauma patient develops dysautonomia and altered mental status and explores therapeutic options for treating a patient with sympathetic storming.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101272"},"PeriodicalIF":0.0,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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