Background : Retropharyngeal hematoma (RPH) is a low-frequency injury that accounts for approximately 1% of all blunt trauma cases and can cause airway narrowing.

　　Case : A 79-year-old woman was admitted to our emergency department with trauma following a traffic accident, and was diagnosed with RPH by computed tomography, revealing that the anteroposterior diameter of the posterior pharyngeal wall gap was C2 12 mm and C6 11.7 mm. Respiratory and circulatory control were well-maintained at the time of admission, but airway stenosis occurred 5 h after admission. Oral intubation was difficult, so cricothyrotomy was performed, with tracheostomy the following day. Airway stenosis improved after the disappearance of the hematoma. The tracheal tube was removed on the 42nd day, and the patient was discharged.

　　Discussion : RPH can cause delayed airway narrowing, so close observation and appropriate airway management are important.

　　An 86-year-old man was injured when his lower abdomen was crushed between heavy machinery and a wall. Computed tomography revealed fluid accumulation in the rectovesical pouch, without the extravasation of contrast medium. Intraperitoneal bleeding and neobladder injury were suspected, prompting emergency laparotomy. The injury site could not be identified. Based on marked hematuria and abdominal fluid with elevated creatinine levels, neobladder injury was diagnosed. The patient was managed by transurethral drainage ; however, persistent marked hematuria and bloody drainage from the abdominal cavity necessitated reoperation. Dissection around the neobladder revealed areas with blood accumulation. Gauze packing around the neobladder and anticoagulant antagonist administration improved the hematuria. This case demonstrates that gauze packing and anticoagulant reversal can be combined to successfully treat traumatic neobladder injury.

　　A healthy female patient in her 70s was referred to our hospital for progressive difficulty in moving caused by a cycling fall that occurred one week previously. Blood tests revealed increased inflammation and bone injury, but significant abscesses were not detected on computed tomography ; however, muscle tissue swelling, including the right iliopsoas, was identified. We diagnosed her with pyomyositis and treated her with antibiotics. Consequently, because blood tests showed worsening inflammation, and computed tomography demonstrated multiple muscle abscesses including the right iliopsoas on day 5, she underwent surgical drainage, and was discharged on day 55. Muscle abscesses may develop from muscle contusion due to minor trauma without minor skin breakdown such as abrasions and bone injury, even in patients with few risk factors for infection.

　　The incidence of fragility fractures of the pelvis (FFP) due to low-energy trauma is increasing in the elderly. Particularly, H- and U-type fractures of FFP type IVb according to the Rommens classification, which are characterized by spinopelvic dissociation, often require spinopelvic fixation. However, in elderly patients with multiple comorbidities, minimally invasive treatments are preferred, such as trans-iliac trans-sacral (TTS) screw fixation. We encountered 2 cases of FFP type IVb fractures treated with TTS screw fixation. Both cases involved H-type fractures, with high-level horizontal fractures at the S2 level. Two TTS screws were inserted into the S1 vertebra, and walking with full weight-bearing was permitted immediately postoperatively. Bone union was achieved at 6 months postoperatively, and the patients returned to their pre-injury level of activities of daily living. While meticulous preoperative planning and reassessment of technical skills are necessary, favorable clinical outcomes can be achieved if two TTS screws are appropriately inserted.