Recent advances in pelvic trauma management have demonstrated the effectiveness of a multidisciplinary approach combining preperitoneal pelvic packing (PPP), angioembolization (AE), and external fixation. However, PPP is a less common procedure in Japan.
　　We experienced 150 cases of severe pelvic trauma (AIS ≥ 4) at our hospital between 2017 and 2024. We retrospectively reviewed 11 patients, all of whom were treated with PPP and survived for more than 30 days. We investigated the incidence of SSI and its associated factors. Median age was 50 years (14-85), with seven males. Mechanisms of injury were : traffic accidents (n = 6), falls (n = 4), and unknown (n = 1). Median ISS was 45 (33-57). AE was performed in nine cases and external fixation in five. Pelvic infection occurred in two patients (18.2%).
　　Although extensively reported, the PPP procedure is not commonly performed. By standardizing the procedure and promoting measures to reduce SSI, it can be applied effectively for the treatment of severe pelvic trauma.

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　　[Objectives] This study investigated the impact of the presence of dedicated physical and occupational therapists in the intensive care unit (ICU) setting on the timing, safety, and efficacy of rehabilitation for patients with severe traumatic brain injury.
　　[Methods] This retrospective cohort study included 63 patients with severe traumatic brain injury (GCS ≤ 8). Patients were divided into two groups : before (pre-dedicated, N = 34) and after (post-dedicated, N = 29). We compared the timing of rehabilitation initiation and first mobilization, incidence of adverse events, outcome related to background factors and hospitalization, duration of mechanical ventilation, complication rates, reintubation rates, and functional independence measure between the two groups.
　　[Results] The post-dedicated group showed significantly earlier rehabilitation initiation and first mobilization. No serious adverse events occurred, and there was no significant difference in adverse event rates between the two groups. The duration of mechanical ventilation was significantly shorter, and the incidences of respiratory complications and reintubation were significantly lower in the post-dedicated group.
　　[Conclusion] The presence of dedicated physical and occupational therapists in the ICU setting enabled earlier rehabilitation initiation and mobilization in patients with severe traumatic brain injury. We found that this approach was safe, with no serious adverse events, and was associated with reductions in mechanical ventilation duration, lower respiratory complications, and reintubation rate.

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　　Objective : To clarify the characteristics of temporary external fixation (EF) for lower extremity fractures in elderly patients.

　　Methods : This study included patients treated with EF for lower extremity fractures in our hospital between April 2014 and March 2024. Patients aged ≥ 75 years old and patients aged 20-74 years old were divided into Groups E and Y, respectively. EF sites, proportion of bedridden status during EF, and the duration of EF were compared between the groups. Proximal EF was defined as femoral fixation for femoral fractures and fractures around the knee.

　　Results : A total of 122 patients were included (32 in Group E, 90 in Group Y). The proportion of proximal EF was significantly higher in Group E than Group Y (53.1% vs. 21.1%). There were no significant differences in the proportion of patients with bedridden status (28.1% in Group E, 20.0% in Group Y) and median EF duration (11 days in Group E, 10.5 days in Group Y).

　　Conclusion : Proximal EF is frequently utilized in elderly patients. We found no significant differences in the proportion of bedridden patients during EF and the EF duration between the elderly and younger patients.

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　　Complex thoracic injuries accompanied by flail chest have traditionally been treated conservatively with mechanical ventilation ; however, prolonged support often leads to complications. Herein, we report a 61-year-old man who sustained severe thoracic trauma, including a sternal fracture, multiple rib fractures with flail chest, pulmonary contusion with hemopneumothorax, and a thoracic vertebral fracture without neurologic deficit. On day 3, surgical fixation of the sternum and ribs with partial lung resection was performed. He was extubated on postoperative day 2, began wheelchair mobilization on day 9, and ultimately returned to sports (martial arts and powerlifting). Early, comprehensive surgical intervention enabled early ventilator weaning, mobilization, and favorable functional recovery in this severe chest and thoracic trauma case.

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　　Simultaneous dislocation fractures of Lisfranc and Chopart joints are extremely rare, typically resulting from high-energy trauma, and they are frequently complicated by foot compartment syndrome and infection. We present a patient with simultaneous dislocation fractures of both joints caused by a crush injury, complicated by compartment syndrome and subsequent wound infection. An emergent fasciotomy was initially performed to treat the compartment syndrome, and infection subsequently developed that was difficult to control. Despite the generally poor prognosis associated with simultaneous Lisfranc and Chopart joint dislocation fractures, the patient ultimately achieved anatomic reduction through open reduction and internal fixation, and retained ambulatory function.

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　　A 72-year-old woman was transferred to a tertiary emergency center after a traffic accident. She was diagnosed with multiple traumatic injuries, including hepatic and splenic injuries, pelvic fracture, and multiple rib fractures complicated by hemopneumothorax. Damage control surgery was performed with abdominal gauze packing for hemostasis and temporary abdominal closure using open abdominal management (OAM), with concurrent damage control resuscitation. Additional hemostasis with transcatheter arterial embolization was required. The patient was transferred to our hospital with a resuscitative endovascular balloon occlusion of the aorta in situ. Emergency hemostasis was successfully achieved. This case suggests that a damage control strategy can be implemented across multiple hospitals for the treatment of patients with multiple trauma undergoing OAM without hemodynamic deterioration.

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　　【Background】Treatment of blunt cervical vascular injury focuses on achieving hemostasis, maintaining cerebral blood flow, and preventing embolic complications.【Case Presentation】A man in his seventies was transferred to our hospital after a motorcycle collision. Contrast-enhanced computed tomography was performed ; however, visualization of the left common carotid and vertebral arteries was not achieved. Digital subtraction angiography revealed a left common carotid artery dissection, for which a self-expanding bare-metal stent was deployed. The origin of the left vertebral artery was occluded ; therefore, a self-expanding covered stent was placed in the left subclavian artery to achieve hemostasis and prevent distal embolization when recanalized. Postoperatively, the patient developed a distal left middle cerebral artery infarction ; nevertheless, he was transferred to a rehabilitation hospital with a modified Rankin Scale score of 2.【Conclusions】This case highlights the clinical trade-off in blunt cervical vascular injury between hemorrhage control and stroke prevention.

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　　In Japan, there has been a decrease in the number of trauma cases. This has made it difficult for surgeons working in secondary emergency hospitals to gain sufficient trauma care experience within their institutions. Herein, we report our experience of two training programs : a 1-month program in 2019 at Chris Hani Baragwanath Academic Hospital in South Africa, and a 6-month program in 2024 at the Acute Care Surgery Division of Teikyo University, an advanced critical care and emergency center in Japan. Our experiences in these programs were compared to evaluate international training in South Africa and domestic training. In South Africa, we gained considerable exposure to penetrating injuries. However, access to imaging was limited, endovascular therapy was difficult, and transfusion systems were not comprehensively provided, thereby limiting direct application of the training to Japanese practice. On the other hand, the domestic training provided extensive experience with multiple blunt trauma cases and elderly patients, allowing for systematic learning of trauma management strategies based on damage control resuscitation. Participation in a broad range of internal emergency surgical cases contributed to our development as surgeons. Hence, establishing and disseminating structured short-term domestic training programs is essential for enhancing trauma care and surgical development in Japan.

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