Trauma Case Reports最新文献_第5页

Aplastic anemia following high-voltage electrical injury: A case report 高压电损伤后再生障碍性贫血1例报告

Q4 Medicine

Trauma Case Reports

Pub Date : 2025-10-02 DOI: 10.1016/j.tcr.2025.101258

Mehdi Ayaz , Dorsa Ayaz , Asma Keshavarz

Introduction

High-voltage electrical injuries (HVEI) can lead to a wide range of complications, including musculoskeletal, neurological, cardiac, and renal damage. Hematological complications are rare but have been reported, with aplastic anemia being an exceptionally uncommon consequence. To date, only two cases of aplastic anemia following HVEI have been documented.

Case presentation

We report the case of a 21-year-old male who sustained a HVEI and developed progressive pancytopenia during hospitalization. Despite stable vital signs and initially normal lab results, his hemoglobin dropped significantly by day 17, followed by a marked decline in white blood cell and platelet counts. Bone marrow biopsy confirmed the diagnosis of aplastic anemia. The patient had no prior hematological conditions or evidence of infection, and his medications were not known to cause bone marrow suppression. He was treated with supportive care, G-CSF, corticosteroids, and Danazol. After several weeks, his blood counts gradually recovered, and full remission was confirmed one month post-discharge.

Discussion

This case highlights the potential for bone marrow suppression and aplastic anemia following HVEI, even in the absence of infection or drug-induced toxicity. The delayed onset of pancytopenia suggests a need for ongoing hematological monitoring in similar patients. This case contributes to the limited literature on this rare complication and emphasizes the importance of early recognition and management.

Conclusion

Aplastic anemia is a rare but serious complication of HVEI. Clinicians should maintain a high index of suspicion for hematological abnormalities in burn patients, particularly in the weeks following injury. Early diagnosis and treatment are essential for favorable outcomes.

高压电损伤（HVEI）可导致广泛的并发症，包括肌肉骨骼、神经、心脏和肾脏损伤。血液学并发症是罕见的，但有报道，再生障碍性贫血是一个非常罕见的后果。迄今为止，只有两例HVEI后再生障碍性贫血被记录在案。我们报告一例21岁的男性患者，他在住院期间患有HVEI并发展为进行性全血细胞减少症。尽管生命体征稳定，最初的化验结果正常，但他的血红蛋白在第17天显著下降，随后白细胞和血小板计数明显下降。骨髓活检确诊为再生障碍性贫血。患者既往无血液学疾病或感染证据，其药物治疗未引起骨髓抑制。他接受支持性护理、G-CSF、皮质类固醇和达那唑治疗。几周后，他的血液计数逐渐恢复，出院后一个月确认完全缓解。本病例强调了HVEI后骨髓抑制和再生障碍性贫血的可能性，即使在没有感染或药物诱导毒性的情况下。全血细胞减少症的延迟发病提示需要对类似患者进行持续的血液学监测。本病例对这一罕见并发症的有限文献有所贡献，并强调了早期识别和治疗的重要性。结论再生障碍性贫血是HVEI罕见但严重的并发症。临床医生应该对烧伤患者的血液学异常保持高度的怀疑，特别是在受伤后的几周内。早期诊断和治疗对于获得良好的预后至关重要。

{"title":"Aplastic anemia following high-voltage electrical injury: A case report","authors":"Mehdi Ayaz , Dorsa Ayaz , Asma Keshavarz","doi":"10.1016/j.tcr.2025.101258","DOIUrl":"10.1016/j.tcr.2025.101258","url":null,"abstract":"<div><h3>Introduction</h3><div>High-voltage electrical injuries (HVEI) can lead to a wide range of complications, including musculoskeletal, neurological, cardiac, and renal damage. Hematological complications are rare but have been reported, with aplastic anemia being an exceptionally uncommon consequence. To date, only two cases of aplastic anemia following HVEI have been documented.</div></div><div><h3>Case presentation</h3><div>We report the case of a 21-year-old male who sustained a HVEI and developed progressive pancytopenia during hospitalization. Despite stable vital signs and initially normal lab results, his hemoglobin dropped significantly by day 17, followed by a marked decline in white blood cell and platelet counts. Bone marrow biopsy confirmed the diagnosis of aplastic anemia. The patient had no prior hematological conditions or evidence of infection, and his medications were not known to cause bone marrow suppression. He was treated with supportive care, G-CSF, corticosteroids, and Danazol. After several weeks, his blood counts gradually recovered, and full remission was confirmed one month post-discharge.</div></div><div><h3>Discussion</h3><div>This case highlights the potential for bone marrow suppression and aplastic anemia following HVEI, even in the absence of infection or drug-induced toxicity. The delayed onset of pancytopenia suggests a need for ongoing hematological monitoring in similar patients. This case contributes to the limited literature on this rare complication and emphasizes the importance of early recognition and management.</div></div><div><h3>Conclusion</h3><div>Aplastic anemia is a rare but serious complication of HVEI. Clinicians should maintain a high index of suspicion for hematological abnormalities in burn patients, particularly in the weeks following injury. Early diagnosis and treatment are essential for favorable outcomes.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101258"},"PeriodicalIF":0.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145332956","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}

引用次数: 0

Corrective osteotomy of proximal diaphyseal deformity of the tibia and tibiotalocalcaneal arthrodesis fixed with a single long retrograde intramedullary nail - a case report 单根长逆行髓内钉固定胫骨近端骨干畸形及胫距跟骨关节融合术1例报告

Q4 Medicine

Trauma Case Reports

Pub Date : 2025-10-02 DOI: 10.1016/j.tcr.2025.101253

Antonio Guilherme Padovani Garofo , Karen Voltan Garofo

The treatment of diaphyseal fractures aims to reestablish the length and angular and rotational alignment of the fractured bone so that the biological process of consolidation can occur. When these objectives are not achieved, deformities or pseudarthrosis may occur. The goal of the arthrodesis described in this paper is to treat pain, stabilize the ankle, and align the limb for plantigrade support, in a patient who suffered with a diaphyseal fracture of the tibia and evolved with mal union and posttraumatic arthrosis of the ankle.

Level of evidence: IV - Case report

骨干骨折的治疗目的是重建骨折骨的长度、角度和旋转对齐，以便发生生物巩固过程。当这些目标不能实现时，可能会发生畸形或假关节。本文所描述的关节融合术的目的是治疗疼痛，稳定踝关节，并对患有胫骨骨干骨折并发展为畸形愈合和创伤后踝关节的患者的肢体进行植底支撑。证据等级：IV -病例报告

引用次数: 0

Diagnosis and management of toe dislocations: Insights from a case series 脚趾脱位的诊断和治疗：来自一个病例系列的见解

Q4 Medicine

Trauma Case Reports

Pub Date : 2025-10-02 DOI: 10.1016/j.tcr.2025.101254

Clara X. Quek , Jun Jie Leeu , Daniel Wei Ren Seng

Toe dislocations can lead to chronic pain and impaired function if not promptly diagnosed and treated. In this paper, we describe a series of complex interphalangeal (IP) and metatarsophalangeal (MTP) joint dislocations and their subsequent surgical interventions. In Case 1, the patient was a 28-year old lady who sustained a left hallux IP joint dislocation after a fall. Case 2 described a 27-year old male with a missed diagnosis of a left fifth MPJ joint dislocation at initial presentation. Both patients underwent open reduction and Kirshner-wiring with good outcomes. In Case 3, a 33-year old lady had a closed fracture-dislocation of the left second metatarsal head and underwent surgical fixation with an uneventful recovery. By reviewing these cases and the current literature, we highlight important factors in diagnosing and managing these injuries.

如果不及时诊断和治疗，脚趾脱位会导致慢性疼痛和功能受损。在本文中，我们描述了一系列复杂的指间（IP）和跖趾（MTP）关节脱位及其随后的手术治疗。在病例1中，患者是一名28岁的女性，在跌倒后发生左拇关节脱位。病例2描述了一名27岁男性，在最初的表现中被误诊为左第五MPJ关节脱位。两例患者均行切开复位和克什纳连接术，结果良好。在病例3中，一名33岁的女性左第二跖骨头闭合性骨折脱位，接受手术固定，恢复良好。通过回顾这些病例和目前的文献，我们强调了诊断和管理这些损伤的重要因素。

引用次数: 0

Use of extracorporeal membrane oxygenation for pediatric post-traumatic pulmonary hemorrhage: A Case report and literature review 体外膜氧合治疗小儿创伤后肺出血1例并文献复习

Q4 Medicine

Trauma Case Reports

Pub Date : 2025-10-02 DOI: 10.1016/j.tcr.2025.101255

Abdulrahman Alwahbi , Abdulrahman Alhowaiti , Abdullah Akkam , Mohammed Tairi , Bandar Alanazi , Saleh Alshehri , Robeyh Assiri

Chest trauma in children presents unique diagnostic challenges due to physiological and anatomical differences from adults. While pulmonary contusion remains the most common injury, meticulous evaluation with CT scan is crucial to rule out occult pathologies and ensure timely intervention for potential complications like alveolar hemorrhage.

Pediatric chest trauma mandates a tailored management approach considering their delicate physiology. Early initiation of high-flow oxygen, judicious ventilatory support for acute respiratory distress, and proactive fluid management are essential, while pain control and hemodynamic monitoring remain critical throughout the recovery process.

Here, we report a challenging case of a 6-year-old male child presenting to the Pediatric Emergency Department with acute moderate-to-severe respiratory distress that was successfully treated with extracorporeal membrane oxygenation.

The child was brought to our emergency department with only history of mild head trauma that occurred 2 h before presenting to the hospital. After triaging as Canadian Triage and Acuity Scale (CTAS) II, the child was managed in line with acute respiratory distress via ATLS abroach. We ruled out head, cervical spine, and other evidence of invasive chest as well as gross abdominal injuries, by ATLS abroach and adjuncts such as point-of-care ultrasound and chest and abdomen X-rays and PAN CT. Although the initial venous blood gas analyses were suggestive of mixed respiratory an metabolic acidosis, the CXR and the chest CT revealed that the child had significant lung parenchymal injury in the form of bilateral fluffy pulmonary infiltrates. This case indicates that even an uncertain history and absence of physical finding, chest blunt trauma causing lung injury, leading to severe manifestations and sometimes fatal complications such as pulmonary contusion, hemorrhage, and ARDS.

由于与成人的生理和解剖学差异，儿童胸部创伤呈现出独特的诊断挑战。虽然肺挫伤仍然是最常见的损伤，但仔细的CT扫描评估对于排除隐性病理和确保及时干预肺泡出血等潜在并发症至关重要。儿童胸部创伤需要量身定制的管理方法，考虑到他们微妙的生理。早期高流量供氧、急性呼吸窘迫时明智的通气支持和积极的液体管理是必不可少的，而疼痛控制和血流动力学监测在整个恢复过程中仍然至关重要。在这里，我们报告了一个具有挑战性的病例，一个6岁的男孩出现在儿科急诊科，患有急性中度至重度呼吸窘迫，并成功地接受了体外膜氧合治疗。该患儿被送往急诊科，入院前2小时仅有轻度头部外伤史。根据加拿大分诊和急性程度量表（CTAS） II进行分类后，通过ATLS方法对患儿进行急性呼吸窘迫处理。我们通过ATLS方法和辅助手段，如现场超声、胸腹x线和PAN CT，排除了头部、颈椎和其他胸部侵入性损伤以及腹部损伤的证据。虽然最初的静脉血气分析提示混合性呼吸和代谢性酸中毒，但CXR和胸部CT显示患儿有明显的肺实质损伤，表现为双侧肺绒毛浸润。本病例提示，即使病史不确定，没有身体检查，胸部钝性创伤引起肺损伤，导致严重的表现和有时致命的并发症，如肺挫伤、出血和ARDS。

{"title":"Use of extracorporeal membrane oxygenation for pediatric post-traumatic pulmonary hemorrhage: A Case report and literature review","authors":"Abdulrahman Alwahbi , Abdulrahman Alhowaiti , Abdullah Akkam , Mohammed Tairi , Bandar Alanazi , Saleh Alshehri , Robeyh Assiri","doi":"10.1016/j.tcr.2025.101255","DOIUrl":"10.1016/j.tcr.2025.101255","url":null,"abstract":"<div><div>Chest trauma in children presents unique diagnostic challenges due to physiological and anatomical differences from adults. While pulmonary contusion remains the most common injury, meticulous evaluation with CT scan is crucial to rule out occult pathologies and ensure timely intervention for potential complications like alveolar hemorrhage.</div><div>Pediatric chest trauma mandates a tailored management approach considering their delicate physiology. Early initiation of high-flow oxygen, judicious ventilatory support for acute respiratory distress, and proactive fluid management are essential, while pain control and hemodynamic monitoring remain critical throughout the recovery process.</div><div>Here, we report a challenging case of a 6-year-old male child presenting to the Pediatric Emergency Department with acute moderate-to-severe respiratory distress that was successfully treated with extracorporeal membrane oxygenation.</div><div>The child was brought to our emergency department with only history of mild head trauma that occurred 2 h before presenting to the hospital. After triaging as Canadian Triage and Acuity Scale (CTAS) II, the child was managed in line with acute respiratory distress via ATLS abroach. We ruled out head, cervical spine, and other evidence of invasive chest as well as gross abdominal injuries, by ATLS abroach and adjuncts such as point-of-care ultrasound and chest and abdomen X-rays and PAN CT. Although the initial venous blood gas analyses were suggestive of mixed respiratory an metabolic acidosis, the CXR and the chest CT revealed that the child had significant lung parenchymal injury in the form of bilateral fluffy pulmonary infiltrates. This case indicates that even an uncertain history and absence of physical finding, chest blunt trauma causing lung injury, leading to severe manifestations and sometimes fatal complications such as pulmonary contusion, hemorrhage, and ARDS.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101255"},"PeriodicalIF":0.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267434","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}

引用次数: 0

Chronic neglected obturator hip dislocation: A case of delayed presentation and management at 8 months 慢性被忽视的闭孔髋关节脱位：一例延迟表现和治疗在8个月

Q4 Medicine

Trauma Case Reports

Pub Date : 2025-10-02 DOI: 10.1016/j.tcr.2025.101256

Mulokozi C. Mutagwaba , Baraka Mponda , John M. Bihagala

Hip obturator dislocations are among the occurrence presentations in high-energy trauma.

In this paper, we report a rare case of an 8-month neglected obturator hip dislocation in a 35-year-old male who presented at our facility. Initially, the patient sought treatment from a traditional healer for 4 months with no success. After examination and investigations, open reduction and internal fixation were performed at our facility, with gradual postoperative rehabilitation. The patient experienced improved range of motion and pain relief at six months follow-up, though some functional limitations persisted. This case emphasises the importance of timely diagnosis and intervention in hip dislocations to prevent long-term complications associated with delayed treatment.

髋关节闭孔脱位是高能创伤的常见表现之一。在本文中，我们报告一个罕见的病例8个月被忽视的闭孔髋关节脱位在一个35岁的男性谁提出了我们的设施。最初，患者向传统治疗师寻求了4个月的治疗，但没有成功。在检查和调查后，在我们的设施进行切开复位和内固定，并逐渐进行术后康复。在六个月的随访中，患者的活动范围得到改善，疼痛得到缓解，但一些功能限制仍然存在。这个病例强调了及时诊断和干预髋关节脱位的重要性，以防止与延迟治疗相关的长期并发症。

引用次数: 0

A comprehensive analysis of traumatic atlanto-occipital and atlanto-axial dislocations: A case series from a level one trauma center 创伤性寰枕和寰枢脱位的综合分析：来自一级创伤中心的病例系列

Q4 Medicine

Trauma Case Reports

Pub Date : 2025-10-02 DOI: 10.1016/j.tcr.2025.101251

Henry Krasner , Sukanta Maitra , Allison G. McNickle

Introduction

Traumatic atlanto-occipital dislocations (AOD) and atlanto-axial dislocations (AAD) are catastrophic injuries of the craniovertebral junction associated with high mortality and long-term morbidity. These injuries' outcomes are often poor due to severe neurological damage and challenges in management. This study aims to provide a comprehensive analysis of AOD and AAD cases at a level one trauma center in the Southwestern United States, in regard to injury characteristics, management strategies, and patient outcomes.

Methods

A retrospective review was conducted on traumatic AOD and AAD patients admitted to a single trauma center between January 1, 2018, and November 14, 2023. Data included demographics, injury mechanism, clinical course, and post-injury outcomes. Patients were categorized into dislocation and subluxation groups. Statistical analyses were performed using Chi-square and independent t-tests when appropriate.

Results

The cohort included 8 dislocations and 13 subluxation patients, with a mean age of 39.25 years. Motor vehicle collisions were the predominant injury mechanism (42.86 %). Patients with dislocations had significantly higher mortality rates compared to subluxations (p = 0.0195). Dislocation patients also had higher rates of concurrent traumatic brain injury (p = 0.024) and cardiorespiratory arrest (p = 0.0014). Survivors often required long-term care, with 0 dislocation patients discharged home post-hospitalization.

Discussion

This study emphasizes the severity of AOD and AAD traumatic injuries. Despite advances in management, these injuries remain highly lethal and result in significant disability for survivors. Our findings emphasize the need for improved diagnostic protocols and early intervention strategies. Future research should focus on multicenter studies to validate current literature and explore novel therapeutic approaches to improve patient outcomes.

外伤性寰枕脱位（AOD）和寰枢脱位（AAD）是颅椎交界处的灾难性损伤，具有高死亡率和长期发病率。由于严重的神经损伤和管理方面的挑战，这些损伤的结果往往很差。本研究旨在对美国西南部一级创伤中心的AOD和AAD病例进行全面分析，包括损伤特征、管理策略和患者预后。方法回顾性分析2018年1月1日至2023年11月14日在某创伤中心收治的创伤性AOD和AAD患者。数据包括人口统计学、损伤机制、临床过程和损伤后结果。患者分为脱位组和半脱位组。统计分析采用卡方检验和独立t检验。结果8例脱位患者，13例半脱位患者，平均年龄39.25岁。机动车碰撞是主要的伤害机制（42.86%）。脱位患者的死亡率明显高于半脱位患者（p = 0.0195）。脱位患者并发创伤性脑损伤（p = 0.024）和心肺骤停（p = 0.0014）的发生率也较高。幸存者通常需要长期护理，0位脱臼患者住院后出院。本研究强调了AOD和AAD创伤性损伤的严重程度。尽管在管理方面取得了进步，但这些伤害仍然是高度致命的，并导致幸存者严重残疾。我们的研究结果强调需要改进诊断方案和早期干预策略。未来的研究应侧重于多中心研究，以验证现有文献，并探索新的治疗方法来改善患者的预后。

{"title":"A comprehensive analysis of traumatic atlanto-occipital and atlanto-axial dislocations: A case series from a level one trauma center","authors":"Henry Krasner , Sukanta Maitra , Allison G. McNickle","doi":"10.1016/j.tcr.2025.101251","DOIUrl":"10.1016/j.tcr.2025.101251","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic atlanto-occipital dislocations (AOD) and atlanto-axial dislocations (AAD) are catastrophic injuries of the craniovertebral junction associated with high mortality and long-term morbidity. These injuries' outcomes are often poor due to severe neurological damage and challenges in management. This study aims to provide a comprehensive analysis of AOD and AAD cases at a level one trauma center in the Southwestern United States, in regard to injury characteristics, management strategies, and patient outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted on traumatic AOD and AAD patients admitted to a single trauma center between January 1, 2018, and November 14, 2023. Data included demographics, injury mechanism, clinical course, and post-injury outcomes. Patients were categorized into dislocation and subluxation groups. Statistical analyses were performed using Chi-square and independent <em>t</em>-tests when appropriate.</div></div><div><h3>Results</h3><div>The cohort included 8 dislocations and 13 subluxation patients, with a mean age of 39.25 years. Motor vehicle collisions were the predominant injury mechanism (42.86 %). Patients with dislocations had significantly higher mortality rates compared to subluxations (<em>p</em> = 0.0195). Dislocation patients also had higher rates of concurrent traumatic brain injury (<em>p</em> = 0.024) and cardiorespiratory arrest (<em>p</em> = 0.0014). Survivors often required long-term care, with 0 dislocation patients discharged home post-hospitalization.</div></div><div><h3>Discussion</h3><div>This study emphasizes the severity of AOD and AAD traumatic injuries. Despite advances in management, these injuries remain highly lethal and result in significant disability for survivors. Our findings emphasize the need for improved diagnostic protocols and early intervention strategies. Future research should focus on multicenter studies to validate current literature and explore novel therapeutic approaches to improve patient outcomes.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101251"},"PeriodicalIF":0.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145267436","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}

引用次数: 0

Fat embolism syndrome following severe blunt chest trauma treated with veno-venous extracorporeal membrane oxygenation: A case report 静脉-静脉体外膜氧合治疗严重钝性胸外伤后脂肪栓塞综合征1例

Q4 Medicine

Trauma Case Reports

Pub Date : 2025-10-02 DOI: 10.1016/j.tcr.2025.101259

Shun Kasahara, Takaaki Maruhashi, Seishiro Akinaga, Ayumi Takahashi, Kanako Okazaki, Marina Oi, Yutaro Kurihara, Yasushi Asari

Background

Fat embolism syndrome (FES) often occurs following long bone fractures and presents with respiratory symptoms in 90 % of cases. Although rare, the mortality rate ranges from 5 % to 20 %. Its pathophysiology involves fat obstruction in the pulmonary arteries or free fatty acids that damage the alveoli. Treatment primarily involves supportive care, including lung-protective ventilation strategies such as acute respiratory distress syndrome (ARDS) management. We report a case of severe FES that required veno-venous extracorporeal membrane oxygenation (VV-ECMO).

Case presentation

A man in his 30s sustained multiple traumatic injuries, including bilateral pneumothorax, unstable pelvic fractures, and multiple rib and limb fractures, after falling from the seventh floor of a building. The Injury Severity Score and probability of survival were 43 and 10.4 %, respectively. The initial management included chest drainage, external pelvic fixation, and massive transfusion. On day 9, the patient developed ARDS (PaO₂/FiO₂ ratio, 100) with features that met the Gurd's criteria for FES. Conventional ARDS therapies were limited owing to existing air leaks and mechanical constraints from pelvic fixation. VV-ECMO was initiated on day 10 alongside lung-rest ventilation and hydrocortisone therapy. The patient's respiratory status improved, allowing ECMO weaning by day 28. The patient was discharged from the intensive care unit on day 62.

Conclusion

VV-ECMO can be life-saving for FES with ARDS, especially when standard treatments are not feasible owing to injury constraints. Early implementation is recommended in select cases to improve outcomes.

背景：脂肪栓塞综合征（FES）常发生在长骨骨折后，90%的病例伴有呼吸系统症状。虽然罕见，但死亡率从5%到20%不等。其病理生理机制包括肺动脉脂肪阻塞或游离脂肪酸损伤肺泡。治疗主要包括支持性护理，包括肺保护性通气策略，如急性呼吸窘迫综合征（ARDS）管理。我们报告一例需要静脉-静脉体外膜氧合（VV-ECMO）的严重FES病例。一名30多岁的男子从一栋建筑的七楼坠落，造成多处创伤，包括双侧气胸、不稳定骨盆骨折、多处肋骨和肢体骨折。损伤严重程度评分和生存率分别为43%和10.4%。最初的治疗包括胸腔引流、骨盆外固定和大量输血。第9天，患者发生ARDS (PaO2/FiO2比值，100)，其特征符合Gurd的FES标准。由于现有的漏气和骨盆固定的机械约束，传统的ARDS治疗受到限制。VV-ECMO于第10天开始，同时进行肺休息通气和氢化可的松治疗。患者的呼吸状况得到改善，允许在第28天进行ECMO脱机。患者于第62天从重症监护病房出院。结论vv - ecmo可以挽救FES合并ARDS患者的生命，特别是在因损伤限制而无法进行标准治疗的情况下。建议在某些情况下尽早实施，以改善结果。

{"title":"Fat embolism syndrome following severe blunt chest trauma treated with veno-venous extracorporeal membrane oxygenation: A case report","authors":"Shun Kasahara, Takaaki Maruhashi, Seishiro Akinaga, Ayumi Takahashi, Kanako Okazaki, Marina Oi, Yutaro Kurihara, Yasushi Asari","doi":"10.1016/j.tcr.2025.101259","DOIUrl":"10.1016/j.tcr.2025.101259","url":null,"abstract":"<div><h3>Background</h3><div>Fat embolism syndrome (FES) often occurs following long bone fractures and presents with respiratory symptoms in 90 % of cases. Although rare, the mortality rate ranges from 5 % to 20 %. Its pathophysiology involves fat obstruction in the pulmonary arteries or free fatty acids that damage the alveoli. Treatment primarily involves supportive care, including lung-protective ventilation strategies such as acute respiratory distress syndrome (ARDS) management. We report a case of severe FES that required veno-venous extracorporeal membrane oxygenation (VV-ECMO).</div></div><div><h3>Case presentation</h3><div>A man in his 30s sustained multiple traumatic injuries, including bilateral pneumothorax, unstable pelvic fractures, and multiple rib and limb fractures, after falling from the seventh floor of a building. The Injury Severity Score and probability of survival were 43 and 10.4 %, respectively. The initial management included chest drainage, external pelvic fixation, and massive transfusion. On day 9, the patient developed ARDS (PaO<sub>2</sub>/FiO<sub>2</sub> ratio, 100) with features that met the Gurd's criteria for FES. Conventional ARDS therapies were limited owing to existing air leaks and mechanical constraints from pelvic fixation. VV-ECMO was initiated on day 10 alongside lung-rest ventilation and hydrocortisone therapy. The patient's respiratory status improved, allowing ECMO weaning by day 28. The patient was discharged from the intensive care unit on day 62.</div></div><div><h3>Conclusion</h3><div>VV-ECMO can be life-saving for FES with ARDS, especially when standard treatments are not feasible owing to injury constraints. Early implementation is recommended in select cases to improve outcomes.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101259"},"PeriodicalIF":0.0,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145221338","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}

引用次数: 0

Selective temporary angioembolisation in older adults with pelvic trauma – Two cases 选择性暂时性血管栓塞治疗老年盆腔创伤2例

Q4 Medicine

Trauma Case Reports

Pub Date : 2025-09-23 DOI: 10.1016/j.tcr.2025.101248

Jan Gewiess , Alois Komarek , Drosos Kotelis , Jose Roshardt , Silviya Ivanova , Thomas Lustenberger , Johannes Dominik Bastian

Hemorrhage is a major concern in the management of high-energy pelvic and acetabular fractures, with complex acetabular patterns often associated with significant blood loss. While angioembolization is well-established in pelvic trauma, its role in temporarily minimizing intraoperative hemorrhage during acetabular fixation remains underexplored.

This report presents two cases of polytraumatized older adults with combined pelvic ring and complex acetabular fractures managed with preoperative selective, temporary angioembolization. Case 1 involved a 76-year-old male with hemorrhagic shock and multiple injuries, including a left associated both-column (ABC) acetabular fracture and superior gluteal artery bleeding. Case 2 involved a 68-year-old male with a right ABC acetabular fracture and multilevel internal iliac artery injury following an avalanche. Both patients underwent early selective angioembolization with gelatin sponge prior to staged fracture fixation using combined intra- and extrapelvic surgical approaches.

In both cases, cumulative intraoperative blood loss was limited to <1200 mL despite the need for extensive fixation involving multiple surgical windows and approaches. Postoperative recovery was favorable, with both patients regaining independent ambulation and functional hip mobility. No embolization-related complications or surgical site infections were observed.

Preoperative bleeding in acetabular fractures often originates from cancellous bone and arterial branches, including the superior gluteal and obturator arteries. Intraoperative hemorrhage remains a significant challenge, particularly in elderly or physiologically compromised patients.

Selective, temporary angioembolization appears to be a promising adjunct for minimizing intraoperative hemorrhage in high-risk patients undergoing combined pelvic and acetabular fracture fixation. Further studies are warranted to evaluate its efficacy and safety in broader clinical contexts.

出血是高能骨盆和髋臼骨折治疗的一个主要问题，复杂的髋臼类型通常与大量失血有关。虽然血管栓塞术在盆腔创伤中的应用已经很成熟，但它在暂时减少髋臼固定术中出血中的作用仍未得到充分的探讨。本报告报告了两例合并骨盆环和复杂髋臼骨折的多创伤老年人术前选择性临时血管栓塞治疗。病例1涉及一名76岁男性失血性休克和多处损伤，包括左相关双柱（ABC）髋臼骨折和臀上动脉出血。病例2为68岁男性，雪崩后右侧ABC髋臼骨折和多节段髂内动脉损伤。两例患者均在分阶段骨折固定前采用盆腔内和盆腔外联合手术入路行明胶海绵选择性血管栓塞。在这两个病例中，尽管需要涉及多个手术窗口和入路的广泛固定，但累计术中出血量限制在1200ml。术后恢复良好，两名患者均恢复独立行走和髋关节功能活动。无栓塞相关并发症或手术部位感染。髋臼骨折的术前出血通常起源于松质骨和动脉分支，包括臀上动脉和闭孔动脉。术中出血仍然是一个重大的挑战，特别是在老年人或生理受损的患者。选择性、暂时性血管栓塞似乎是一种很有前途的辅助手段，可以减少高危患者行骨盆和髋臼联合骨折固定术中出血。需要进一步的研究来评估其在更广泛的临床环境中的有效性和安全性。

{"title":"Selective temporary angioembolisation in older adults with pelvic trauma – Two cases","authors":"Jan Gewiess , Alois Komarek , Drosos Kotelis , Jose Roshardt , Silviya Ivanova , Thomas Lustenberger , Johannes Dominik Bastian","doi":"10.1016/j.tcr.2025.101248","DOIUrl":"10.1016/j.tcr.2025.101248","url":null,"abstract":"<div><div>Hemorrhage is a major concern in the management of high-energy pelvic and acetabular fractures, with complex acetabular patterns often associated with significant blood loss. While angioembolization is well-established in pelvic trauma, its role in temporarily minimizing intraoperative hemorrhage during acetabular fixation remains underexplored.</div><div>This report presents two cases of polytraumatized older adults with combined pelvic ring and complex acetabular fractures managed with preoperative selective, temporary angioembolization. Case 1 involved a 76-year-old male with hemorrhagic shock and multiple injuries, including a left associated both-column (ABC) acetabular fracture and superior gluteal artery bleeding. Case 2 involved a 68-year-old male with a right ABC acetabular fracture and multilevel internal iliac artery injury following an avalanche. Both patients underwent early selective angioembolization with gelatin sponge prior to staged fracture fixation using combined intra- and extrapelvic surgical approaches.</div><div>In both cases, cumulative intraoperative blood loss was limited to <1200 mL despite the need for extensive fixation involving multiple surgical windows and approaches. Postoperative recovery was favorable, with both patients regaining independent ambulation and functional hip mobility. No embolization-related complications or surgical site infections were observed.</div><div>Preoperative bleeding in acetabular fractures often originates from cancellous bone and arterial branches, including the superior gluteal and obturator arteries. Intraoperative hemorrhage remains a significant challenge, particularly in elderly or physiologically compromised patients.</div><div>Selective, temporary angioembolization appears to be a promising adjunct for minimizing intraoperative hemorrhage in high-risk patients undergoing combined pelvic and acetabular fracture fixation. Further studies are warranted to evaluate its efficacy and safety in broader clinical contexts.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101248"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145119293","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}

引用次数: 0

Retrograde gluteal cleft sacral screw fixation for a transverse sacral fracture (AO A3) with cauda equina: A technical note 臀裂骶骨逆行螺钉固定治疗伴有马尾的骶骨横骨折（aoa3）：技术说明

Q4 Medicine

Trauma Case Reports

Pub Date : 2025-09-22 DOI: 10.1016/j.tcr.2025.101249

Laurens K.P. Aerden , Michiel Herteleer

Introduction

Isolated horizontal sacral fractures that do not influence pelvic ring stability are rare. Several techniques to stabilize these fractures have been described. This technical note describes a technique of retrograde screw fixation in a 75-year-old female with severe osteoporosis and large Tarlov cysts in the sacrum. It is a minimally invasive, navigation assisted technique that allowed to reduce the fracture and stabilize it adequately.

不影响骨盆环稳定性的孤立性水平骶骨骨折是罕见的。已经介绍了几种稳定这些骨折的技术。本文介绍了一种逆行螺钉固定技术，用于治疗一位75岁女性严重骨质疏松症和骶骨大Tarlov囊肿。这是一种微创的导航辅助技术，可以使骨折复位并充分稳定。

引用次数: 0

Quantitative assessment of fracture healing using patient-specific CT finite element analysis: A novel approach to external fixation management 使用患者特异性CT有限元分析定量评估骨折愈合：一种新的外固定管理方法

Q4 Medicine

Trauma Case Reports

Pub Date : 2025-08-22 DOI: 10.1016/j.tcr.2025.101245

Yusuke Matsuura , Takahiro Yamazaki , Seiji Ohtori

Background

Posttreatment decisions regarding fracture care primarily rely on physicians' subjective judgment based on clinical and imaging findings. This study aimed to evaluate whether patient-specific computed tomography (CT) finite element analysis could allow for the quantitative assessment of fracture site strength as an objective indicator of treatment decisions.

Methods

Our patient was a 37-year-old male who underwent external fixation for an open comminuted tibial fracture of the right lower leg. Monthly CT scans were taken starting 2 months postinjury. Patient-specific CT finite element analysis was used to evaluate weight-bearing capacity both with external fixation and after its removal. Treatment decisions were based on the analysis of the minimum principal strain and callus failure risk in the callus region.

Results

For the first 3 months postfixation, destructive strain occurred in the callus even with the external fixator, indicating a risk for nonunion with full weight bearing. At 4 months postsurgery, the mechanical stability of the callus improved, indicating potential bone union under daily activity loads. At 5 months, CT images showed partial callus bridging in the posterior tibia, with finite element analysis demonstrating its capacity for withstanding loads of up to 1724 N after external fixator removal. These results suggest the need for careful management of weight-bearing load early after external fixation.

Conclusion

This study demonstrated the possibility of implementing postoperative weight-bearing management among patients with external fixation based on quantitative assessment using patient-specific CT finite element analysis rather than relying solely on clinical experience. Further accumulation of clinical data is expected to improve analytical accuracy and contribute to the establishment of fracture treatments based on more objective indicators.

Clinical relevance

This study demonstrated the potential clinical application of patient-specific CT finite element analysis in fracture treatment.

背景：骨折治疗后护理的决定主要依赖于医生基于临床和影像学表现的主观判断。本研究旨在评估患者特异性计算机断层扫描（CT）有限元分析是否可以定量评估骨折部位强度，作为治疗决策的客观指标。方法患者为37岁男性，右小腿开放性粉碎性胫骨骨折行外固定手术。损伤后2个月开始每月进行CT扫描。采用患者特异性CT有限元分析评估外固定物前后的负重能力。治疗决策是基于对最小主应变和愈伤组织失效风险的分析。结果在固定后的前3个月，即使使用外固定架，骨痂也会发生破坏性应变，这表明完全负重时存在骨不愈合的风险。术后4个月，骨痂的机械稳定性得到改善，表明在日常活动负荷下骨愈合的潜力。5个月时，CT图像显示胫骨后侧部分骨痂桥接，有限元分析显示其在取出外固定架后可承受高达1724 N的载荷。这些结果提示外固定术后早期需要仔细管理负重。结论本研究证明了采用基于患者特异性CT有限元分析的定量评估来实施外固定物患者术后负重管理的可能性，而不是单纯依靠临床经验。临床数据的进一步积累有望提高分析的准确性，并有助于建立基于更客观指标的骨折治疗方法。临床相关性本研究证明了患者特异性CT有限元分析在骨折治疗中的潜在临床应用。

{"title":"Quantitative assessment of fracture healing using patient-specific CT finite element analysis: A novel approach to external fixation management","authors":"Yusuke Matsuura , Takahiro Yamazaki , Seiji Ohtori","doi":"10.1016/j.tcr.2025.101245","DOIUrl":"10.1016/j.tcr.2025.101245","url":null,"abstract":"<div><h3>Background</h3><div>Posttreatment decisions regarding fracture care primarily rely on physicians' subjective judgment based on clinical and imaging findings. This study aimed to evaluate whether patient-specific computed tomography (CT) finite element analysis could allow for the quantitative assessment of fracture site strength as an objective indicator of treatment decisions.</div></div><div><h3>Methods</h3><div>Our patient was a 37-year-old male who underwent external fixation for an open comminuted tibial fracture of the right lower leg. Monthly CT scans were taken starting 2 months postinjury. Patient-specific CT finite element analysis was used to evaluate weight-bearing capacity both with external fixation and after its removal. Treatment decisions were based on the analysis of the minimum principal strain and callus failure risk in the callus region.</div></div><div><h3>Results</h3><div>For the first 3 months postfixation, destructive strain occurred in the callus even with the external fixator, indicating a risk for nonunion with full weight bearing. At 4 months postsurgery, the mechanical stability of the callus improved, indicating potential bone union under daily activity loads. At 5 months, CT images showed partial callus bridging in the posterior tibia, with finite element analysis demonstrating its capacity for withstanding loads of up to 1724 N after external fixator removal. These results suggest the need for careful management of weight-bearing load early after external fixation.</div></div><div><h3>Conclusion</h3><div>This study demonstrated the possibility of implementing postoperative weight-bearing management among patients with external fixation based on quantitative assessment using patient-specific CT finite element analysis rather than relying solely on clinical experience. Further accumulation of clinical data is expected to improve analytical accuracy and contribute to the establishment of fracture treatments based on more objective indicators.</div></div><div><h3>Clinical relevance</h3><div>This study demonstrated the potential clinical application of patient-specific CT finite element analysis in fracture treatment.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"60 ","pages":"Article 101245"},"PeriodicalIF":0.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145020587","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}

引用次数: 0