Penetrating Trauma Research Articles

Endoscopy-assisted vitrectomy for severe ocular penetrating trauma with corneal opacity.

To assess the utility and efficiency of endoscopy-assisted vitrectomy (EAV) for the treatment of corneal opacity in severe ocular trauma. Patients who underwent fundus examination using a preoperative slit lamp and intraoperative endoscopy, followed by EAV and additional surgery were retrospectively recruited. Silicone oil removal and penetrating keratoplasty were used in selected eyes at postoperative follow-ups. Outcome measurements included the best corrected visual acuity (BCVA), intraocular pressure (IOP), findings of endoscopic fundus examination, and postoperative complications. Twenty-one eyes with severe ocular trauma and corneal opacity were followed up for 24-36mo. Retinal detachment (RD) and vitreous haemorrhage (VH) were identified in 16 eyes (76.2%), RD only in four eyes (19.0%), and VH combined with intraocular foreign body in one eye (4.8%). All eyes underwent at least three surgeries. Stage-I surgeries involved wound closure (100%), lens extraction (76.2%), and anterior vitrectomy (14.3%). Stage-II surgeries involved scleral buckling (28.6%), membrane peeling (47.6%), retinal laser photocoagulation (100%) and silicone oil tamponade (100%) using EAV. Stage-III surgeries were conducted using endoscopy including silicone oil removal (52.4%), retinal laser photocoagulation (52.4%) and penetrating keratoplasty (28.6%). Nearly all eyes showed improvements in BCVA and IOP. Although there were no severe complications, glaucoma was noted in one eye, chronic hypotony in another eye, and band keratopathy in three eyes. EAV is an effective adjunct for restoring ocular anatomical structures and visual function in the case of corneal opacity after severe ocular trauma.

Navigating Hemorrhagic Shock: Biomarkers, Therapies, and Challenges in Clinical Care

Hemorrhagic shock remains a leading cause of preventable death worldwide, with mortality patterns varying significantly based on injury mechanisms and severity. This comprehensive review examines the complex pathophysiology of hemorrhagic shock, focusing on the temporal evolution of inflammatory responses, biomarker utility, and evidence-based therapeutic interventions. The inflammatory cascade progresses through distinct phases, beginning with tissue injury and endothelial activation, followed by a systemic inflammatory response that can transition to devastating immunosuppression. Recent advances have revealed pattern-specific responses between penetrating and blunt trauma, necessitating tailored therapeutic approaches. While damage control resuscitation principles and balanced blood product administration have improved outcomes, many molecular targeted therapies remain investigational. Current evidence supports early hemorrhage control, appropriate blood product ratios, and time-sensitive interventions like tranexamic acid administration. However, challenges persist in biomarker validation, therapeutic timing, and implementation of personalized treatment strategies. Future directions include developing precision medicine approaches, real-time monitoring systems, and novel therapeutic modalities while addressing practical implementation barriers across different healthcare settings. Success in hemorrhagic shock management increasingly depends on integrating multiple interventions across different time points while maintaining focus on patient-centered outcomes.

Selective nonoperative management of abdominal gunshot wounds: What you need to know.

Since the 1990s, there has been a slow but steady adoption of selective nonoperative management (SNOM) for abdominal gunshot wounds (GSW). Multiple studies have shown that SNOM is feasible and can be performed safely, even at trauma centers with low penetrating trauma volumes. The principles of SNOM for abdominal GSW consists of (1) careful patient selection, (2) diagnostic workup with CT, and (3) clinical observation. By implementing SNOM, the number of patients undergoing a nontherapeutic laparotomy can significantly be improved to less than 10%. Overall, approximately one third of patients with abdominal GSW can be managed nonoperatively. This review article provides a practical approach to the management of patients with an abdominal GSW.

Systematic inflammatory indicators and clinical management of exogenous endophthalmitis due to metal penetrating injury of eyeball

ObjectiveTo evaluate systemic inflammatory markers in cases of exogenous endophthalmitis caused by metal foreign bodies after penetrating eye injury and identify risk factors for poor control post-initial emergency surgery.MethodsTwenty-nine patients with exogenous endophthalmitis underwent emergency surgery with vitrectomy at Xiamen Eye Center (2016–2024). Evaluations included systemic inflammatory markers, microbiology, clinical presentation, treatment strategies, complications, prognostic factors, and visual outcomes. Correlation analysis was performed between blood test results and disease control after initial surgery.ResultsThe median patient age was 44.8 ± 16.9 years, with an average treatment delay of 6.1 ± 10.6 days. Males represented 86.2% (n = 25), and 41.3% (n = 12) had metallic intraocular foreign bodies, which correlated with faster symptom onset (p < 0.05) and higher inflammatory markers (WBC, neutrophils, basophils, CRP; p < 0.05). Primary lens extraction and intraoperative vancomycin did not significantly improve control (p > 0.05). Poor control post-vitrectomy was positively correlated with intraocular foreign bodies (R = 0.39, p < 0.05) and negatively with lymphocyte and monocyte counts (R = −0.43, p < 0.05; R = −0.46, p < 0.05). Early intervention within 2 h of symptom exacerbation reduced complication risk (AUC = 0.708, 95% CI: 0.547–0.838, p = 0.047).ConclusionMetallic intraocular foreign bodies provoke stronger systemic inflammatory responses, posing control challenges, especially in patients with lower immune resilience. Timely vitrectomy during initial emergency surgery is crucial for managing endophthalmitis.

An Analysis of 24-Hour Survival Based on Arrival by Atypical Ground Transport Versus Ground Emergency Medical Services

Objectives Studies comparing police, privately owned vehicle (POV), and ground Emergency Medical Services (GEMS) trauma transports reveal mixed results. It remains unclear whether using nonstandard transport methods may be beneficial in the setting of certain injuries. We sought to determine 24-h survival after transport by police or POV when compared to GEMS. Methods We analyzed data from the Trauma Quality Improvement Program datasets from 2020 to 2022 for patients arriving from scene by POV, police, or GEMS. The primary outcome was 24-h survival. Multivariable logistic regression models were used to adjust for confounders. Further stratification was performed by mechanism. We used abbreviated Injury Severity Score (ISS) by body region to assess those with and without penetrating torso trauma. Results Patients arriving by POV had a lower median age than those arriving by GEMS and a higher proportion of pediatric patients. This group exhibited a lower incidence of blunt trauma but a higher incidence of penetrating trauma, along with fewer serious injuries across all body regions. Across all adjusted models, arrival by POV was associated with higher odds of 24-h survival, except for cases of penetrating torso trauma among pediatric patients. Patients arriving by police also had a lower median age but a reduced proportion of pediatric patients. This group showed a higher proportion of penetrating trauma and serious injuries to the thorax and abdomen. Police arrivals with blunt trauma had higher odds of 24-h survival, while those with penetrating trauma had lower odds of 24-h survival, a pattern consistent when stratifying by ISS greater than 15. Conclusions This study highlights a survival advantage for trauma patients transported by POV compared to GEMS. Limitations include a lack of prehospital transport time and intervention data. While police transport showed improved survival for blunt trauma, it was associated with worse outcomes for penetrating trauma. These findings suggest that nontraditional transport methods may be beneficial in certain scenarios. Future research should aim to refine transport protocols, investigate the impact of nontraditional methods on transport time, and better understand the impact of prehospital interventions on patient outcomes.

To remove or not to remove: Intraconal metallic foreign body following perforating ocular injury

Background: Foreign bodies (FB) are implicated in 17-30% of penetrating ocular injuries. We encountered 2 cases of perforating ocular trauma with metallic intra-orbital FB in 2 teenage males. Case report: A 17-year-old male presented with a nail-hammer injury 6 hours after trauma. Snellen’s acuity was 3/60 with a corneal laceration of 5mm with lens matter in the anterior chamber and vitreous hemorrhage. After primary repair by the anterior segment surgeon, posterior segment surgery was done following the diagnosis of retinal detachment (RD) and intra-ocular Foreign Body(FB) by ultrasound. No FB was noted intraoperatively. On Computerized Tomography (CT), metallic FB 5.2x3.5 mm was noted at the insertion of the inferior oblique muscle. Removal of IOFB was deferred by the oculoplasty department. Delayed oil removal was done with final Snellen’s acuity 6/12p. Another 16-year-old male attended the retina clinic 20 days after injury with a metal-on-metal hammering incident. Primary topical management was done elsewhere. Snellen’s acuity was 6/18p in the affected eye. The site of FB entry was scleral,1.4 mm from limbus at 9 o’clock with no associated lens trauma. CT scan of the brain and orbit showed intra-orbital FB medial to the medial rectus near the orbital apex. FB (4.4x4.3 mm) left a tract in subretinal space to enter intraconal space 1 disc diameter nasal to optic disc. Vitrectomy was done for tractional RD and postoperative Snellen’s vision was 6/12. Conclusion: A high degree of clinical suspicion is necessary to detect and localize IOFB. Non-toxic intra-orbital FB may be left in the context of good vision in the affected eye and possible iatrogenic optic nerve damage.

Forensic Analysis of Electrical Injury Patterns: A Study of Electrocution Fatalities at SMS Medical College Jaipur

Objective: To provide an in-depth forensic analysis of the types and locations of electrical injuries observed in electrocution deaths, focusing on the presence of entry and exit wounds, the voltage involved, and associated burns. Methods: This hospital-based observational study examined 75 cases of electrocution fatalities autopsied at the mortuary of SMS Medical College Jaipur from June 2021 to June 2022. Data on demographics, injury types, wound locations, voltage levels, and burn patterns were collected and analyzed. Descriptive statistics were used to summarize the data, and chi-square tests assessed the significance of categorical variables. Results: Among the 75 cases, males accounted for 92% of the victims, with the majority aged 21-30 years (34.4%). Upper limb injuries were predominant (38.67%), and both entry and exit wounds were present in 48% of cases. Low voltage (65.33%) was the most common electrical source, and flame burns were observed in 44% of the cases. Shock – Septicaemia was the primary cause of death (58.66%). Conclusions: This study highlights the forensic significance of analysing injury patterns in electrocution deaths. Understanding these patterns aids in determining the cause and manner of death, emphasizing the need for preventive measures and public awareness to reduce such fatalities.

Factors associated with decisions to refer possible abusive head trauma to a hospital-based child protection team in Aotearoa New Zealand.

Aotearoa New Zealand has a high incidence of abusive head trauma (AHT) and a national children's hospital with an established multi-disciplinary child protection team (CPT). Staff concerned about possible AHT are expected to refer to the CPT, but there has been no research into the factors which might influence those referral decisions. To identify factors associated with decisions to refer head-injured children to the CPT, and to assess whether those factors are consistent with the literature. All children <5years old admitted from 2010 to 2019 with skull fracture or intracranial injury. Retrospective review comparing 25 variables in cases referred and not referred. Multivariable analysis estimated the independent role of each variable and modelled their combined contribution to decisions to refer. The area under the receiver operator characteristic curve (AUROC) and 95% CI were used to describe performance of the model. Of 631 head-injured children, 265 (42%) were referred and 121 (19%) diagnosed as AHT/undetermined. Variables associated with referral decisions were age<1year, p=.0001; injury inconsistent with the history, p<.0001; certain categories of history (motor vehicle accident, no history, history of abuse, fall <1m, blunt force and penetrating trauma), p<.0001; delayed presentation, p<.0001; past history of injury, p=.0001; social/behavioral concerns, p<.0001 and subdural hemorrhage, p=.01. The AUROC was 0.95 (95% CI 0.93, 0.97). Factors associated with referral are generally consistent with the literature. The percentage referred seems justified given the number diagnosed as AHT/undetermined.

Three-Dimensional Modeling of Firearm Injuries in Forensic Medicine

Introduction. Forensic medical investigations, including illustration, evidence collection, and expert conclusion preparation, have faced significant challenges in recent years. One of the primary challenges for Ukraine’s forensic medical service today is the examination of firearm-related injuries, necessitating substantial improvements to traditional methodologies. The study aimed to develop a methodology for the three-dimensional spatial reconstruction of firearm injuries. Methods. An automatic pistol CZ83 of medium caliber, manufactured in the Czech Republic and chambered for 7.65x17 mm ammunition, was used in the study. Roma Plastilina No. 1 ballistic gelatin, produced in the USA, served as the target and reproducing material for controlled ballistics tests. The experiments included 15 shots, during which the main morphological elements of skin injury, the subcutaneous adipose tissue, and the wound channel at the entry, middle, and exit points were studied. These were photographed, analyzed using photogrammetry, and converted into a three-dimensional format with the graphic editors Agisoft PhotoScan and 3Ds Max. Results. Measurements of all parameters obtained through classical methods differed significantly (p&lt;0.05) from those obtained using 3D modeling. However, Cohen’s d values indicated that the differences were very small for defect size measurements, small for the abrasion ring and wound channel diameter across all sections, and medium for the entry wound diameter. Conclusions. The developed methodology for three-dimensional modeling allows for the accurate recording of the main morphometric parameters of firearm injuries, making it a viable alternative to traditional measurement methods.

Encephalic and spinal subdural empyema secondary to a puncture wound on the skull of a dog with late neurological signs

Encephalic and spinal subdural empyema secondary to a puncture wound on the skull of a dog with late neurological signs

Evaluation of Microbiology and Antibiotic Prescribing Behavior of Foot Puncture Wound Infection: An Opportunity for Antimicrobial Stewardship

Evaluation of Microbiology and Antibiotic Prescribing Behavior of Foot Puncture Wound Infection: An Opportunity for Antimicrobial Stewardship

Trauma video review analysis: Increased provider movement impedes trauma team performance

IntroductionTrauma team performance, measured by the non-technical skills scale T-NOTECHS, has been shown to impact patient outcomes. We assess how personnel movements affect non-technical skills and time of resuscitation(TOR) using trauma video review. MethodsA prospective study of blunt and/or penetrating trauma activations recorded between May and November 2023 ​at a Level-I trauma center. Regressions controlling for confounders were used to measure the association between foot traffic and the outcomes of interest1: TOR2 T-NOTECHS score(Smith et al., 2015; Mackenzie et al., 2007; Maiga et al., 2024; Vella et al., 2024; Pucher et al., 2014; Dumas et al., 2020; Succar et al., 2024; Steinemann et al., 2012; Andersson et al., 2012; Conrad et al., 2010; Lies and Zhang, 2015) .5-155-15 ResultsWe identified 77 trauma activations, with 40 ​%(n ​= ​32/77) penetrating injuries. There was a median of 17[14–18] individuals at the start of trauma activations. During resuscitations, individuals entered the room a median of 12[8–18] times and exited the room 17[11–22] times. The median TOR was 8[6–10] min and the median T-NOTECHS was 7[6–8]. Regression analysis showed foot traffic was independently associated with increased TOR(β 0.34, p-value <0.01) and worse total T-NOTECHS score(β 0.06, p ​< ​0.01). ConclusionsHigher foot traffic is associated with poorer team performance and delays in resuscitation. Future directions should further explore environmental and personal factors that may impede performance metrics.

A case of faecopneumothorax resulting from a delayed diagnosis of traumatic diaphragmatic injury

Diaphragmatic hernia is a rare condition that can result from blunt or penetrating trauma. It is often asymptomatic for years, making diagnosis challenging. In fact, up to 66% of diaphragmatic ruptures can go unnoticed at the time of trauma. Delayed diagnosis can lead to complications, including faecopneumothorax. Faecopneumothorax caused by strangulated diaphragmatic hernia is an extremely rare clinical condition. We report the case of a 15-year-old Iranian female who had a history of a motor vehicle accident 1 year prior to being referred to our center. She presented with tension faecopneumothorax, which occurred due to the incarceration and strangulation of the large bowel in the thoracic cavity. the patient was urgently transferred to the operating room for exploratory surgery. In patients presenting with symptoms of pulmonary or intestinal obstruction and a history of thoracoabdominal injury, the clinician should consider diaphragmatic hernia as a potential diagnosis. Prompt recognition of this condition is crucial as complications can significantly increase morbidity and mortality rates.

Penetrating intracranial injury from a pencil in a pediatric patient: illustrative case.

Intracranial penetrating injuries from a pencil are exceptionally rare. The most common mechanism is a child running while holding a pencil. Potential consequences of intracranial pencil injury include direct trauma to brain structures, vascular injury, and intracranial abscess formation. A 3-year-old girl was at daycare and had fallen while running with a pencil. Computed tomography showed a pencil penetrating the left parietal bone through the left temporal lobe, terminating in the posterior limb of the internal capsule. Cerebral angiography was performed prior to the removal of the pencil to rule out vascular injury. Angiography of the left carotid artery revealed slight irregularity in the left M2 but no active extravasation. The patient was then taken to the operating room to have the pencil removed. Postoperatively, she did well and was discharged home after 6 days with no neurological deficits. Pencils are rare causes of intracranial injury in children. Definitive vascular imaging prior to pencil removal to rule out vascular injury and minimize the risk of hemorrhage after removal is recommended. Intraoperative irrigation and debridement, followed by antibiotics, are recommended to avoid abscess formation. Follow-up vascular imaging is recommended to rule out pseudoaneurysm. https://thejns.org/doi/10.3171/CASE24494.

Multidisciplinary standardized protocol decreases time to antibiotic administration for open fractures.

Wound complications after open fracture are common, including superficial and deep infections. Many factors may contribute to outcomes after open fracture, including comorbidities, injury location and characteristics, timing and quality of surgical debridement, and soft tissue coverage. Early prophylactic antibiotic administration is one of the few modifiable factors demonstrated to reduce infection rates. Retrospective comparative study at a single Level 1 Trauma Center evaluated patients age > 18 who presented directly to and were admitted with open long-bone fracture. Primary outcome measure was time from arrival to antibiotic administration pre- and post-implementation of a standardized open fracture protocol. Secondary analysis evaluated percentage of patients receiving antibiotics within one hour for open long-bone fracture, injury characteristics and patient demographics influence on time to antibiotics. Median time to antibiotic administration improved post-protocol (69min vs. 39min, p < 0.001). Patients receiving antibiotics within one hour improved after protocol implementation (42.9% vs. 79.0%, p < 0.001). Antibiotic administration was more often delayed for patients with penetrating injuries compared to blunt injuries (80min vs. 54min, p = 0.003). Patients with penetrating injuries were less likely to receive antibiotics within one hour (46% vs 56%, p < 0.001). The implementation of a standardized protocol reduced the time to antibiotic administration and increased the percentage of patients with open fractures receiving antibiotics within one hour. Penetrating injuries were often not appreciated as open fractures during the initial evaluation, which led to a delay in antibiotic administration. Level III, Therapeutic/Care Management.

Management of subarachnoid-pleural fistula following anterior transthoracic approach for the ossification of posterior longitudinal ligament in the thoracic spine.

Subarachnoid-pleural fistula is an abnormal communication between the subarachnoid and pleural spaces that can arise from blunt or penetrating trauma or as a complication of spinal surgery via the transthoracic approach. Uncontrolled cerebrospinal fluid (CSF) leakage with a fistulous condition after transthoracic spinal surgery could be more problematic than that after spinal surgery via the conventional posterior approach because of the negative pressure in the pleural cavity. The authors reported subarachnoid-pleural fistula management using chest and lumbar spinal drainage in five patients with several troublesome complications, such as intracranial subdural hematoma or severe respiratory dysfunction. Chest drainage was managed for 2-3 days by continuous low negative pressure, whereas lumbar spinal drainage was managed for 5-7 days, aiming at an output volume of 150-200 ml/day and higher than that of chest drainage. Additionally, when examining changes in the accumulated pleural fluid were examined by standing chest X-ray immediately before operation and 1 month after operation, the pleural effusions in four of the five patients were assimilated 1 month postoperatively. Compared with CSF management following standard posterior spinal surgery, management after the anterior transthoracic approach could be more troublesome because of intrapleural negative pressure. When chest and lumbar spinal drainage are used, it is important to consider that over-drainage of CSF could potentially cause severe respiratory dysfunction and intracranial subdural hematoma.

A case of Japanese spotted fever with purpura fulminans.

Early intervention is imperative in cases of JSF due to its potentially fatal trajectory if diagnosed belatedly. JSF should be contemplated in the differential diagnosis when generalized purpura, accompanied by a pronounced inflammatory response, is noted, even in the absence of a puncture wound.

Transorbitary intracranial penetrating injury involving bicycle brake handle: case report and literature review

Transorbitary intracranial penetrating injury involving bicycle brake handle: case report and literature review

Evaluation of New Mental Health Diagnoses After Pediatric Traumatic Injuries at a Level 1 Pediatric Trauma Center.

Traumatic injury is associated with significant mental health morbidity. To evaluate the need for implementation of active-post injury mental health screening at a Level 1 Pediatric Trauma center, we aimed to characterize all new mental health diagnoses after injury and evaluated for patient or injury factors that may aid in targeting of future screening. A single-center retrospective analysis of trauma patients aged 6-18years presenting in 2022 was performed. Our primary outcome was a new DSM-5 mental health diagnosis documented after traumatic injury. Patients with and without a new mental health diagnosis were compared by age, sex, race, ethnicity, injury type/mechanism, injury severity score (ISS), intensive care unit (ICU) admission, and length of stay (LOS). 492 patients were included. Their median (IQR) age was 13.5 (10.4, 15.4) years. The median (IQR) follow-up interval was 157 (9, 429) days. There were 24 (4.9%) children with a new mental health diagnosis: 12 (50%) with trauma-related stress disorders, with the remaining having diagnoses such as depressive or anxiety disorders. Patients with a new mental health diagnosis had longer LOS (3.0 [1.8, 7.5] vs 2.0 [1.0, 3.3] days, P = 0.02) and were more likely to have sustained penetrating injury (P = 0.01). There were no differences in demographics, rates of preexisting mental health diagnosis or area deprivation index (P > 0.05). There were fewer new mental health diagnoses in our cohort than expected, likely underestimating the acute need. Comprehensive post-injury screening is imperative to sufficiently identify and intervene upon mental health morbidity after pediatric trauma.

Traumatic Diaphragmatic Rupture Leading to Tension Gastrothorax: A Critical Case Report and Surgical Insight

Traumatic diaphragmatic rupture (TDR) is a serious but relatively uncommon injury, often resulting from blunt trauma, particularly motor vehicle accidents. Among these, blunt TDR presents with more severe outcomes than penetrating injuries, including higher mortality rates. A life-threatening complication of TDR is gastrothorax, which occurs when the stomach herniates into the thoracic cavity, leading to elevated intrathoracic pressure and potentially fatal consequences such as respiratory failure or cardiac arrest. This case reported a 23-year-old male who sustained a motor vehicle collision, presenting with progressive shortness of breath, nausea, and vomiting 15 hours post-injury. Imaging confirmed a diaphragmatic rupture with associated tension gastrothorax. Immediate intervention with nasogastric tube placement provided symptom relief, followed by exploratory laparotomy to repair the diaphragmatic defect. The patient's recovery was uneventful, demonstrating the critical importance of early diagnosis and timely surgical management in cases of TDR with gastrothorax. Traumatic diaphragmatic rupture occurs in approximately 0.8–1.6% of trauma cases, with motor vehicle accidents being the leading cause. Due to its potential for delayed diagnosis, the rupture is often missed initially, leading to higher rates of morbidity and mortality. Early detection is critical, as it can prevent serious complications such as bowel herniation into the thoracic cavity, respiratory distress, or even death.