Purpose : To investigate open pelvic fracture cases and characterize their clinical picture and initial management strategies. Methods : This single-center retrospective study involved seven patients with open pelvic fractures treated at our hospital between 2015 and 2019. Results : All seven patients had unstable pelvic fractures and a median abbreviated injury scale [AIS, version 90-98] of 5 [interquartile range, 4.5-5] , with open wounds in Zone 1 of the Faringer classification, and classified as Class 3 of the Jones-Powell classification. Six patients required massive transfusion, all seven patients underwent transcatheter arterial embolization and fixation with a pelvic binder, three received gauze packing of an open wound, and six underwent external pelvic fixation. All patients had a colostomy ; this procedure was performed urgently in four patients with and three without anorectal injury, but there was a risk of wound contamination. There were two in-hospital mortalities : one from sepsis due to deep infection in an open wound, and one due to multiple organ failure. There were no deaths due to acute hemorrhage. Conclusion : In cases of open pelvic fractures, prompt hemostasis and infection control with timely colostomy are important.

　　A 37-year-old man was admitted to our hospital after a traffic accident. He was in hemorrhagic shock due to pelvic fractures. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed to control the bleeding. Contrast-enhanced computed tomography revealed intraperitoneal and retroperitoneal hemorrhage. An emergency laparotomy revealed active bleeding from the root of the sigmoid colon mesentery, which was temporarily controlled by compression with gauze. The treatment strategy was changed from laparotomy to transcatheter arterial embolization (TAE) to embolize both internal iliac arteries. After TAE, sigmoid colon resection, rectal resection, and colostomy were performed. The patient underwent further TAE and repeated laparotomy. Finally, he was transferred to another hospital for rehabilitation. A damage control strategy that included REBOA, damage control surgery, and damage control interventional radiology helped manage life-threatening trauma.

　　Transiliac-transsacral screw (TITS) fixation is a minimally invasive procedure for pelvic ring fractures in the elderly. However, the diagnosis, treatment, and prevention of vascular injury as a complication remains limited. Herein, we present a 70-year-old man who underwent percutaneous TITS fixation for a Rommens type IIc fragility fracture of the pelvic ring. After surgery, a pseudoaneurysm was found in the deep branch of the superior gluteal artery (DSGA) adjacent to the TITS insertion site at S2. Coil embolization was performed. After embolization, there was no further deterioration in anemia, and bone union was observed. The distance between the TITS insertion point and the DSGA was small ; thus, there was an increased risk of arterial injury. When inserting TITS, it is important to confirm the course of the superior gluteal artery branch by contrast-enhanced CT before surgery and to ensure the safe performance of surgery with adequate protection of the surrounding tissue.

　　We report a case of traumatic occipitoatlantal dislocation without neurological sequelae. The patient was a male in his 20s with no comorbidities. The cause of the injury was a direct hit to the right side of the head by heavy machinery. His chief complaint was right-sided head pain and neck pain. He had bleeding from the right external auditory canal. There were no abnormal neurological findings. We diagnosed an annular occipital bone dislocation. After a halo vest was placed, the patient was intubated using a bronchoscope. The patient then underwent occipital bone-C2/3 fixation. Traumatic occipitoatlantal dislocation may have a poor neurological prognosis due to delayed diagnosis. If there is soft tissue swelling or subarachnoid hemorrhage in the craniocervical transition region on CT, an annular occipital bone dislocation should be suspected and evaluated by at least two different methods. Early diagnosis, appropriate external fixation, and proper intubation are important.

　　We report a case of recurrent late-onset pneumothorax in a patient with chest trauma requiring resection of a fractured rib. A 38-year-old man was referred to our hospital after suffering 7th-11th right rib fractures resulting from a fall. On the ninth day after injury, CT showed right pneumothorax. Chest tube drainage was performed, and the patient was discharged after the pneumothorax was resolved. However, right pneumothorax recurred twice. We considered that the end of the fractured 9th right rib, protruding into the thoracic cavity, had caused pneumothorax. On the 111th day after injury, thoracoscopic partial resection of the 9th right rib was performed. We recommend that cases of lower and floating rib fractures with sharp edges, in contact with intrathoracic organs, and with an acute angle to the chest wall of 25° or greater, be considered for surgical treatment.