Contralateral acute epidural hematoma development following a decompressive craniectomy for an acute subdural hematoma is a rare but fatal complication. Early recognition and treatment can be lifesaving.
Observation
We present 2 cases of a new onset massive contralateral acute epidural hematoma development following decompressive craniectomy and hematoma evacuation for acute subdural hematoma, each with different course of the pathology and post-operative outcome.
Lessons
Even after a decompressive craniectomy for a structural primary lesion, neurologic follow-up and immediate control CT scans of patients with severe traumatic brain injury (TBI) can help us identify this very uncommon complication. Additionally, these two cases demonstrate the significance of prompt detection and intervention, which can dramatically change the pathology's progression and neurologic outcome.
{"title":"New onset contralateral acute epidural hematoma following decompressive craniectomy for an acute subdural hematoma: A report of 2 cases","authors":"Dawit Workneh Gechu , Mehari Wale Alem , Yordanos Girma Legesse","doi":"10.1016/j.tcr.2025.101236","DOIUrl":"10.1016/j.tcr.2025.101236","url":null,"abstract":"<div><h3>Background</h3><div>Contralateral acute epidural hematoma development following a decompressive craniectomy for an acute subdural hematoma is a rare but fatal complication. Early recognition and treatment can be lifesaving.</div></div><div><h3>Observation</h3><div>We present 2 cases of a new onset massive contralateral acute epidural hematoma development following decompressive craniectomy and hematoma evacuation for acute subdural hematoma, each with different course of the pathology and post-operative outcome.</div></div><div><h3>Lessons</h3><div>Even after a decompressive craniectomy for a structural primary lesion, neurologic follow-up and immediate control CT scans of patients with severe traumatic brain injury (TBI) can help us identify this very uncommon complication. Additionally, these two cases demonstrate the significance of prompt detection and intervention, which can dramatically change the pathology's progression and neurologic outcome.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"59 ","pages":"Article 101236"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902321","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}
Trifocal, non-contiguous, ipsilateral tibial fractures involving the plateau, diaphysis and ankle are extremely rare, with limited literature to guide their optimal surgical management. These complex injuries demand a strategic approach to achieve stable reduction and fixation, maintain implant compatibility and enable early rehabilitation.
Case report
We report a case of a 60-year-old male who sustained a high energy trifocal fracture of the left tibia following blunt trauma from a falling gate. Imaging revealed a tibial plateau fracture (AO 41C2.2), a long spiral diaphyseal fracture (AO 43C1.3) and a comminuted bimalleolar fracture (AO 44B3.3). Surgical management involved open reduction and internal fixation (ORIF) of the tibial plateau via a posteromedial approach, intramedullary nailing (IMN) of the tibial diaphysis via a suprapatellar approach and ORIF of the bimalleolar fracture using a lateral fibular locking plate and tension band wiring for the medial malleolus. Meticulous preoperative planning and precise implant placement prevented hardware conflict between fixation zones. Post-operatively, a structured rehabilitation protocol was followed. At the final follow-up of 18 months, the patient demonstrated excellent functional outcomes, with near-complete restoration of knee and ankle range of motion, evidenced by a Tegner Lysholm knee score of 96 % and an American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of 95 %.
Conclusion
This case illustrates a successful approach to managing a rare, complex trifocal tibial fracture using combined plating and nailing techniques. Careful preoperative planning, fixation sequencing and early mobilization are key to achieving optimal outcomes in such injuries.
{"title":"All-in-one trifocal ipsilateral tibial fractures: A case report on comprehensive surgical fixation of tibial plateau, shaft and bimalleolar fractures","authors":"Siva Srivastava Garika , Nitish Jagdish Jyoti, Asjad Mahmood, Vijay Sharma, Kamran Farooque","doi":"10.1016/j.tcr.2025.101241","DOIUrl":"10.1016/j.tcr.2025.101241","url":null,"abstract":"<div><h3>Introduction</h3><div>Trifocal, non-contiguous, ipsilateral tibial fractures involving the plateau, diaphysis and ankle are extremely rare, with limited literature to guide their optimal surgical management. These complex injuries demand a strategic approach to achieve stable reduction and fixation, maintain implant compatibility and enable early rehabilitation.</div></div><div><h3>Case report</h3><div>We report a case of a 60-year-old male who sustained a high energy trifocal fracture of the left tibia following blunt trauma from a falling gate. Imaging revealed a tibial plateau fracture (AO 41C2.2), a long spiral diaphyseal fracture (AO 43C1.3) and a comminuted bimalleolar fracture (AO 44B3.3). Surgical management involved open reduction and internal fixation (ORIF) of the tibial plateau via a posteromedial approach, intramedullary nailing (IMN) of the tibial diaphysis via a suprapatellar approach and ORIF of the bimalleolar fracture using a lateral fibular locking plate and tension band wiring for the medial malleolus. Meticulous preoperative planning and precise implant placement prevented hardware conflict between fixation zones. Post-operatively, a structured rehabilitation protocol was followed. At the final follow-up of 18 months, the patient demonstrated excellent functional outcomes, with near-complete restoration of knee and ankle range of motion, evidenced by a Tegner Lysholm knee score of 96 % and an American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of 95 %.</div></div><div><h3>Conclusion</h3><div>This case illustrates a successful approach to managing a rare, complex trifocal tibial fracture using combined plating and nailing techniques. Careful preoperative planning, fixation sequencing and early mobilization are key to achieving optimal outcomes in such injuries.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"59 ","pages":"Article 101241"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144893431","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 : 2025-08-21DOI: 10.1016/j.tcr.2025.101242
Muhammed Cetinkaya , Frederik Flensted Andersen , Poul Pedersen , Dennis Karimi , Tazio Maleitzke
Septic arthritis (SA) of the wrist is a rare and challenging condition that requires rapid treatment to prevent irreversible joint damage. We present a unique case of a hematogenously spread SA of the wrist caused by Streptococcus pyogenes, secondary to a temporal abscess. The patient, a previously healthy 36-year-old man without known risk factors aside from occasional alcohol consumption, exhibited wrist pain without fever or overt signs of infection. One week prior, he had suffered a temporal laceration and a non-displaced trapezoid fractur following a minor fall on his head and hand. In the following days, the patient developed fever, signs of infection around the temporal wound, and increasing wrist pain, ultimately leading to the diagnosis of a temporal abscess and SA of the wrist.
Multiple surgical debridements were necessary alongside targeted intravenous antibiotic therapy, to successfully eradicate the wrist infection. Despite appropriate treatment, the patient experienced persistent pain and functional limitations of the wrist five months later.
This case underscores the importance of early diagnosis and treatment of SA in cases of joint pain in combination with a potential infection elsewhere in the body. The case emphasizes the critical role of timely surgical intervention in managing SA of the wrist.
{"title":"Streptococcus pyogenes induced septic arthritis of the wrist secondary to a temporal abscess and trapezoid fracture - A case report","authors":"Muhammed Cetinkaya , Frederik Flensted Andersen , Poul Pedersen , Dennis Karimi , Tazio Maleitzke","doi":"10.1016/j.tcr.2025.101242","DOIUrl":"10.1016/j.tcr.2025.101242","url":null,"abstract":"<div><div>Septic arthritis (SA) of the wrist is a rare and challenging condition that requires rapid treatment to prevent irreversible joint damage. We present a unique case of a hematogenously spread SA of the wrist caused by <em>Streptococcus pyogenes</em>, secondary to a temporal abscess. The patient, a previously healthy 36-year-old man without known risk factors aside from occasional alcohol consumption, exhibited wrist pain without fever or overt signs of infection. One week prior, he had suffered a temporal laceration and a non-displaced trapezoid fractur following a minor fall on his head and hand. In the following days, the patient developed fever, signs of infection around the temporal wound, and increasing wrist pain, ultimately leading to the diagnosis of a temporal abscess and SA of the wrist.</div><div>Multiple surgical debridements were necessary alongside targeted intravenous antibiotic therapy, to successfully eradicate the wrist infection. Despite appropriate treatment, the patient experienced persistent pain and functional limitations of the wrist five months later.</div><div>This case underscores the importance of early diagnosis and treatment of SA in cases of joint pain in combination with a potential infection elsewhere in the body. The case emphasizes the critical role of timely surgical intervention in managing SA of the wrist.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"59 ","pages":"Article 101242"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902320","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}
Traumatic diaphragmatic hernia (TDH) is an uncommon condition resulting from high-energy blunt trauma or penetrating injuries. Right-sided TDH accounts for a small proportion of diaphragmatic ruptures. Early diagnosis remains a major challenge, with a significant number of cases diagnosed late, which increases morbidity and mortality by a substantial increase. Computed tomography (CT), particularly for right-sided TDH, is a diagnostic modality with high sensitivity and specificity. We report two cases of right-sided TDH with hepatic herniation following blunt trauma. The first case involved a 30-year-old male who sustained high-energy trauma in a motor vehicle collision. Hemodynamically stable, he underwent CT imaging that confirmed the diagnosis. He was treated via laparotomy with surgical repair and had a prolonged ICU stay due to rhabdomyolysis and pneumonia, ultimately discharged in good condition. The second case involved a 72-year-old female pedestrian struck by a bus. She also presented hemodynamically stable, underwent CT, and received early surgical repair via laparotomy. She was discharged on postoperative day three with favorable recovery. These cases highlight the importance of high clinical suspicion based on trauma mechanism, the role of CT in stable patients, and the value of early diagnosis and surgical management in achieving favorable outcomes. At one-year follow-up, the patient remained asymptomatic, with no recurrence or functional respiratory limitations on clinical examination.
{"title":"Right-sided diaphragmatic hernia with hepatic herniation after blunt trauma: Report of two cases of early diagnosis and treatment","authors":"Isabella Martelli Rocca , Luiz Scaglione , Bianca Argentino , Vinicius Teixeira , José Mauro Silva Rodrigues , Marcelo A.F. Ribeiro Jr.","doi":"10.1016/j.tcr.2025.101243","DOIUrl":"10.1016/j.tcr.2025.101243","url":null,"abstract":"<div><div>Traumatic diaphragmatic hernia (TDH) is an uncommon condition resulting from high-energy blunt trauma or penetrating injuries. Right-sided TDH accounts for a small proportion of diaphragmatic ruptures. Early diagnosis remains a major challenge, with a significant number of cases diagnosed late, which increases morbidity and mortality by a substantial increase. Computed tomography (CT), particularly for right-sided TDH, is a diagnostic modality with high sensitivity and specificity. We report two cases of right-sided TDH with hepatic herniation following blunt trauma. The first case involved a 30-year-old male who sustained high-energy trauma in a motor vehicle collision. Hemodynamically stable, he underwent CT imaging that confirmed the diagnosis. He was treated via laparotomy with surgical repair and had a prolonged ICU stay due to rhabdomyolysis and pneumonia, ultimately discharged in good condition. The second case involved a 72-year-old female pedestrian struck by a bus. She also presented hemodynamically stable, underwent CT, and received early surgical repair via laparotomy. She was discharged on postoperative day three with favorable recovery. These cases highlight the importance of high clinical suspicion based on trauma mechanism, the role of CT in stable patients, and the value of early diagnosis and surgical management in achieving favorable outcomes. At one-year follow-up, the patient remained asymptomatic, with no recurrence or functional respiratory limitations on clinical examination.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"59 ","pages":"Article 101243"},"PeriodicalIF":0.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892744","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 : 2025-08-19DOI: 10.1016/j.tcr.2025.101244
Mohamed Guelbi , Mohamed Hajri , Aziz Atallah , Zied Hadrich , Hafedh Mestiri , Sahir Omrani
Introduction
Celiac trunk dissection is an extremely rare vascular injury in the setting of blunt abdominal trauma, accounting for less than 0.01 % of all trauma cases. Despite its rarity, this condition carries significant clinical relevance due to the celiac artery's role in perfusing vital upper abdominal organs. Clinical presentation varies widely, and diagnosis is often incidental during imaging for trauma evaluation. Management strategies range from conservative therapy to endovascular or surgical intervention, depending on the clinical context.
Presentation of case
We report the case of a 44-year-old woman who presented to the emergency department after being struck by a vehicle. She was hemodynamically stable and reported upper abdominal pain. Contrast-enhanced CT scan revealed an isolated dissection of the celiac trunk, with preserved distal perfusion and no associated organ injury or ischemia. The patient was managed conservatively with anticoagulation, blood pressure control, and close monitoring. Her condition remained stable, and she was discharged on antiplatelet therapy. Follow-up was uneventful.
Discussion
Celiac artery dissection following blunt trauma is a diagnostic challenge due to its variable and often subtle clinical presentation. A high index of suspicion and appropriate arterial-phase CT imaging are essential for timely diagnosis. Most stable patients without ischemic complications can be managed nonoperatively, provided adequate collateral circulation exists. Endovascular or surgical interventions are reserved for patients with flow-limiting lesions, pseudoaneurysms, or hemodynamic instability.
Conclusion
Isolated celiac trunk dissection after blunt trauma is a rare but potentially serious condition. Early diagnosis, multidisciplinary evaluation, and individualized management are key to favorable outcomes. Conservative treatment is often effective in stable patients, while endovascular or surgical approaches should be considered in select cases with complications.
{"title":"Isolated celiac trunk dissection following blunt abdominal trauma: A case report and review of the literature","authors":"Mohamed Guelbi , Mohamed Hajri , Aziz Atallah , Zied Hadrich , Hafedh Mestiri , Sahir Omrani","doi":"10.1016/j.tcr.2025.101244","DOIUrl":"10.1016/j.tcr.2025.101244","url":null,"abstract":"<div><h3>Introduction</h3><div>Celiac trunk dissection is an extremely rare vascular injury in the setting of blunt abdominal trauma, accounting for less than 0.01 % of all trauma cases. Despite its rarity, this condition carries significant clinical relevance due to the celiac artery's role in perfusing vital upper abdominal organs. Clinical presentation varies widely, and diagnosis is often incidental during imaging for trauma evaluation. Management strategies range from conservative therapy to endovascular or surgical intervention, depending on the clinical context.</div></div><div><h3>Presentation of case</h3><div>We report the case of a 44-year-old woman who presented to the emergency department after being struck by a vehicle. She was hemodynamically stable and reported upper abdominal pain. Contrast-enhanced CT scan revealed an isolated dissection of the celiac trunk, with preserved distal perfusion and no associated organ injury or ischemia. The patient was managed conservatively with anticoagulation, blood pressure control, and close monitoring. Her condition remained stable, and she was discharged on antiplatelet therapy. Follow-up was uneventful.</div></div><div><h3>Discussion</h3><div>Celiac artery dissection following blunt trauma is a diagnostic challenge due to its variable and often subtle clinical presentation. A high index of suspicion and appropriate arterial-phase CT imaging are essential for timely diagnosis. Most stable patients without ischemic complications can be managed nonoperatively, provided adequate collateral circulation exists. Endovascular or surgical interventions are reserved for patients with flow-limiting lesions, pseudoaneurysms, or hemodynamic instability.</div></div><div><h3>Conclusion</h3><div>Isolated celiac trunk dissection after blunt trauma is a rare but potentially serious condition. Early diagnosis, multidisciplinary evaluation, and individualized management are key to favorable outcomes. Conservative treatment is often effective in stable patients, while endovascular or surgical approaches should be considered in select cases with complications.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"59 ","pages":"Article 101244"},"PeriodicalIF":0.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879174","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 : 2025-08-18DOI: 10.1016/j.tcr.2025.101235
Vincent Marcucci , Clement Rajakumar , Emmanuel Ihionkhan , Joseph Moorman , James Botta , Victoriya Staab
Penetrating gunshot wounds to the heart are rare in children but can lead to severe complications requiring urgent intervention. This report describes a case of a 14-year-old male who sustained a gunshot wound to the anterior chest from a high-velocity pellet rifle, resulting in hemopericardium, cardiac tamponade, and potential injury to the right coronary artery. Following emergency surgery and the successful evacuation of a clot containing the pellet, the patient experienced ventricular fibrillation and was subsequently taken for percutaneous coronary intervention due to a middle right coronary arterial occlusion. Two drug-eluting stents were placed, restoring blood flow to distal vessels. Postoperatively, the patient was managed with antiplatelet therapy, including ticagrelor and aspirin. The case highlights the successful use of cardiac catheterization in a pediatric trauma patient and underscores the need for further research on optimal antiplatelet therapy in this population to prevent complications such as restenosis and stent thrombosis.
{"title":"Self-inflicted gunshot wound to the right coronary artery in a pediatric patient resulting in sternotomy and coronary artery stenting","authors":"Vincent Marcucci , Clement Rajakumar , Emmanuel Ihionkhan , Joseph Moorman , James Botta , Victoriya Staab","doi":"10.1016/j.tcr.2025.101235","DOIUrl":"10.1016/j.tcr.2025.101235","url":null,"abstract":"<div><div>Penetrating gunshot wounds to the heart are rare in children but can lead to severe complications requiring urgent intervention. This report describes a case of a 14-year-old male who sustained a gunshot wound to the anterior chest from a high-velocity pellet rifle, resulting in hemopericardium, cardiac tamponade, and potential injury to the right coronary artery. Following emergency surgery and the successful evacuation of a clot containing the pellet, the patient experienced ventricular fibrillation and was subsequently taken for percutaneous coronary intervention due to a middle right coronary arterial occlusion. Two drug-eluting stents were placed, restoring blood flow to distal vessels. Postoperatively, the patient was managed with antiplatelet therapy, including ticagrelor and aspirin. The case highlights the successful use of cardiac catheterization in a pediatric trauma patient and underscores the need for further research on optimal antiplatelet therapy in this population to prevent complications such as restenosis and stent thrombosis.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"59 ","pages":"Article 101235"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879175","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 : 2025-08-18DOI: 10.1016/j.tcr.2025.101237
Nicolas Franulic , Sebastian Bianchi , Sebastián Blanco , Juan Cristóbal Uribe , Nicolas Gaggero , Rodrigo Olivieri
Bone defects around the knee represent a major challenge, with multiple therapeutic alternatives such as mosaicplasty for managing minor defects or the use of patellar autograft for unicondylar defects.
Currently, polymethylmethacrylate (PMMA) has demonstrated biomechanical advantages for treating non-contained bone defects around the knee, with failure loads exceeding those of a native knee.
The aim of this paper is to present two cases in which PMMA plus cannulated screws were used as salvage treatment in the context of non-reconstructable bone defects. One patient developed knee stiffness, which was treated with arthroscopic fibroarthrolysis and mobilization under anesthesia. Both patients achieved an acceptable range of motion after rehabilitation and were able to return to work.
In light of the evidence, these salvage techniques may represent a viable option for transitional reconstruction of defects around the knee, offering advantages such as immediate stability, early weight-bearing, low cost, easy reproducibility, and the possibility of immediate local antibiotic treatment.
{"title":"Femoral arthroplasty with bone cement as a salvage measure in open fracture with articular bone defect in young patients","authors":"Nicolas Franulic , Sebastian Bianchi , Sebastián Blanco , Juan Cristóbal Uribe , Nicolas Gaggero , Rodrigo Olivieri","doi":"10.1016/j.tcr.2025.101237","DOIUrl":"10.1016/j.tcr.2025.101237","url":null,"abstract":"<div><div>Bone defects around the knee represent a major challenge, with multiple therapeutic alternatives such as mosaicplasty for managing minor defects or the use of patellar autograft for unicondylar defects.</div><div>Currently, polymethylmethacrylate (PMMA) has demonstrated biomechanical advantages for treating non-contained bone defects around the knee, with failure loads exceeding those of a native knee.</div><div>The aim of this paper is to present two cases in which PMMA plus cannulated screws were used as salvage treatment in the context of non-reconstructable bone defects. One patient developed knee stiffness, which was treated with arthroscopic fibroarthrolysis and mobilization under anesthesia. Both patients achieved an acceptable range of motion after rehabilitation and were able to return to work.</div><div>In light of the evidence, these salvage techniques may represent a viable option for transitional reconstruction of defects around the knee, offering advantages such as immediate stability, early weight-bearing, low cost, easy reproducibility, and the possibility of immediate local antibiotic treatment.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"59 ","pages":"Article 101237"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144902335","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 : 2025-08-18DOI: 10.1016/j.tcr.2025.101240
Kazuo Sato , Tatsuhiro Ishijima , Kenichi Kusunoki , Toshiki Yoshino , Mizuki Minegishi , Yoshio Nishida , Hiroko Murakami , Yoshihiko Tsuchida , Hiroki Bota , Yuta Izawa
Autologous vein grafting is a common method for revascularization in cases of traumatic limb arterial injuries. However, no clear guidelines have been established regarding the use of tourniquets following vascular reconstruction. We report a case of graft thrombosis that occurred during a planned orthopedic surgery one week after the initial revascularization. The patient was a 56-year-old man with a complex ligament injury of the left knee accompanied by a popliteal artery injury. After admission to our hospital, he underwent emergency popliteal artery reconstruction using an autologous vein graft. On postoperative day 8, the patient underwent ligament reconstruction under tourniquet control, which resulted in the thrombotic occlusion of the graft. Although repeat vein grafting was attempted intraoperatively, blood flow could not be restored. Ultimately, an endovascular stent was deployed in the popliteal artery, which successfully restored perfusion. At one-year follow-up, the stent remained patent without evidence of fracture or vascular stenosis. This case highlights the potential risk of tourniquet-induced graft thrombosis, particularly in the early postoperative period. Excessive pressure and dilation of a harvested vein may damage the intimal layer, thereby increasing thrombosis risk. In patients with recent vascular reconstruction, especially those at high-risk, the use of tourniquet should be carefully considered. When necessary, meticulous planning and prophylactic strategies are crucial to minimize the risk of graft failure.
{"title":"A case of popliteal artery injury associated with multiligamentous knee injury successfully managed with endovascular stenting after thrombotic occlusion following vein graft revascularization","authors":"Kazuo Sato , Tatsuhiro Ishijima , Kenichi Kusunoki , Toshiki Yoshino , Mizuki Minegishi , Yoshio Nishida , Hiroko Murakami , Yoshihiko Tsuchida , Hiroki Bota , Yuta Izawa","doi":"10.1016/j.tcr.2025.101240","DOIUrl":"10.1016/j.tcr.2025.101240","url":null,"abstract":"<div><div>Autologous vein grafting is a common method for revascularization in cases of traumatic limb arterial injuries. However, no clear guidelines have been established regarding the use of tourniquets following vascular reconstruction. We report a case of graft thrombosis that occurred during a planned orthopedic surgery one week after the initial revascularization. The patient was a 56-year-old man with a complex ligament injury of the left knee accompanied by a popliteal artery injury. After admission to our hospital, he underwent emergency popliteal artery reconstruction using an autologous vein graft. On postoperative day 8, the patient underwent ligament reconstruction under tourniquet control, which resulted in the thrombotic occlusion of the graft. Although repeat vein grafting was attempted intraoperatively, blood flow could not be restored. Ultimately, an endovascular stent was deployed in the popliteal artery, which successfully restored perfusion. At one-year follow-up, the stent remained patent without evidence of fracture or vascular stenosis. This case highlights the potential risk of tourniquet-induced graft thrombosis, particularly in the early postoperative period. Excessive pressure and dilation of a harvested vein may damage the intimal layer, thereby increasing thrombosis risk. In patients with recent vascular reconstruction, especially those at high-risk, the use of tourniquet should be carefully considered. When necessary, meticulous planning and prophylactic strategies are crucial to minimize the risk of graft failure.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"59 ","pages":"Article 101240"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144903788","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 : 2025-08-18DOI: 10.1016/j.tcr.2025.101238
Jaehyun Park, Seungyup Shin, Gyeonggyu Choi, Sungho Lee
Case
We present a case of an elderly female patient with a chronic lower leg wound involving bone exposure in the tibia. Despite the absence of overt infection, low-grade osteomyelitis was suspected. Given the patient's age and overall fitness, we opted for a staged reconstructive approach using negative pressure wound therapy (NPWT), followed by sequential pedicled muscle flaps and skin grafting. This method was favored over free flap reconstruction due to patient-specific factors and the aim of minimizing donor site morbidity. The outcome was functionally and aesthetically satisfactory, with no signs of flap failure or recurrent infection.
Conclusion
This case highlights the utility of staged reconstruction using local muscle flaps combined with NPWT in elderly patients, offering a limb-salvaging alternative to free tissue transfer in selected cases.
{"title":"Staged reconstruction of the traumatic large soft-tissue defect in the leg","authors":"Jaehyun Park, Seungyup Shin, Gyeonggyu Choi, Sungho Lee","doi":"10.1016/j.tcr.2025.101238","DOIUrl":"10.1016/j.tcr.2025.101238","url":null,"abstract":"<div><h3>Case</h3><div>We present a case of an elderly female patient with a chronic lower leg wound involving bone exposure in the tibia. Despite the absence of overt infection, low-grade osteomyelitis was suspected. Given the patient's age and overall fitness, we opted for a staged reconstructive approach using negative pressure wound therapy (NPWT), followed by sequential pedicled muscle flaps and skin grafting. This method was favored over free flap reconstruction due to patient-specific factors and the aim of minimizing donor site morbidity. The outcome was functionally and aesthetically satisfactory, with no signs of flap failure or recurrent infection.</div></div><div><h3>Conclusion</h3><div>This case highlights the utility of staged reconstruction using local muscle flaps combined with NPWT in elderly patients, offering a limb-salvaging alternative to free tissue transfer in selected cases.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"59 ","pages":"Article 101238"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144865955","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 : 2025-08-18DOI: 10.1016/j.tcr.2025.101234
Nogognan Ignace Lengane , Milckisédek Judicaël Marouruana Somé , Charles Ilboudo , Solo Traoré , Bertin Priva Ouédraogo
Thyroid gland hematoma following blunt neck trauma is a rare but potentially life-threatening condition due to the risk of airway compromise. While it most commonly occurs in goitrous glands, unusual mechanisms of trauma can still make such cases exceptional. We present a case of thyroid haematoma following scarf-related neck strangulation in a patient with a longstanding goitre. Although uncommon, thyroid injury should be considered in cases of neck trauma or swelling. Stable hematomas without airway compromise can be managed conservatively. Surgical intervention is warranted primarily when airway obstruction is threatened.
{"title":"Thyroid hematoma after blunt neck trauma","authors":"Nogognan Ignace Lengane , Milckisédek Judicaël Marouruana Somé , Charles Ilboudo , Solo Traoré , Bertin Priva Ouédraogo","doi":"10.1016/j.tcr.2025.101234","DOIUrl":"10.1016/j.tcr.2025.101234","url":null,"abstract":"<div><div>Thyroid gland hematoma following blunt neck trauma is a rare but potentially life-threatening condition due to the risk of airway compromise. While it most commonly occurs in goitrous glands, unusual mechanisms of trauma can still make such cases exceptional. We present a case of thyroid haematoma following scarf-related neck strangulation in a patient with a longstanding goitre. Although uncommon, thyroid injury should be considered in cases of neck trauma or swelling. Stable hematomas without airway compromise can be managed conservatively. Surgical intervention is warranted primarily when airway obstruction is threatened.</div></div>","PeriodicalId":23291,"journal":{"name":"Trauma Case Reports","volume":"59 ","pages":"Article 101234"},"PeriodicalIF":0.0,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885471","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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