A previously healthy 14-year-old boy was brought to the hospital after colliding with a glass door. He was admitted with worsening abdominal pain and diagnosed with a liver injury. Interventional radiology was performed and the patient achieved hemodynamic stabilization. Right-sided diaphragmatic rupture was suspected on imaging. Therefore, pleural effusion and ascitic fluid were obtained via puncture and compared using biochemical analysis. The similarity in characteristics between the fluid samples was suggestive of a diaphragmatic rupture. A diagnostic thoracoscopy identified a 4 cm laceration at the apex of the right diaphragm, which was repaired by suturing using a thoracic approach. Right-sided diaphragmatic rupture without hernia is difficult to diagnose ; however, in this case, the use of multiple tests improved diagnostic accuracy, allowing for timely and effective diagnostic, surgical, and treatment interventions.

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　　An 86-year-old woman was transferred to our hospital for treatment of a rectal foreign body. Examination revealed a gardening pole protruding from the anus. CT revealed the object had perforated the anterior rectal wall, traversed the abdominal cavity, and penetrated the sacrum into the spinal canal. An emergency laparotomy was performed, and the object was removed transanally. No cerebrospinal fluid leakage or bleeding from the sacral venous plexus was observed. The rectum and mesentery were repaired, a drain was placed at the site of spinal canal communication, and a colostomy was created for fecal diversion. Postoperatively, broad-spectrum antibiotics were administered to prevent meningitis. The patient recovered without complications and was transferred to another facility on postoperative day 28. In cases of rectal impalement injuries extending to the sacral canal, thorough debridement, effective drainage, fecal diversion, and early broad-spectrum antibiotic therapy may allow the patient to be treated without serious complications.

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　　A male patient in his 70s sustained a head injury and spinal fractures after a 5-meter fall. He presented with C1 and C5-6 fractures, C7 fracture-dislocation, and spinal cord injury. Imaging revealed occlusion of the left internal carotid artery and right vertebral artery, diagnosed as Denver Grading Scale IV. He was fully conscious without hemiparalysis or aphasia and underwent posterior cervical fixation and laminoplasty. On postoperative day 3, his consciousness deteriorated, and right upper limb paralysis developed. Magnetic resonance imaging confirmed diffuse cerebral infarction in the left middle cerebral artery territory. Antithrombotic therapy was contraindicated due to recent surgery ; therefore, conservative management was adopted. By day 25, the patient’s consciousness had improved ; however, paralysis persisted, and he was transferred. Traumatic internal carotid artery occlusion carries a high risk of ischemic stroke and mortality. When antithrombotic therapy is infeasible, angiographic evaluation and endovascular interventions should be considered to prevent cerebral infarction.

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　　[Aim] The aim of this study was to investigate the types of fractures in patients admitted to our center who received a pelvic circumferential compression device, and to assess changes in fracture displacement following device placement.
　　[Methods] Fracture type was classified based on imaging at admission. In cases where images were available both with and without a pelvic circumferential compression device in place, the changes in displacement at the fracture site were investigated.
　　[Results] We included 47 patients (32 men and 15 women), with a mean age of 54.0 ± 24.3 (15-101) years. The fracture types were : no fracture (24 cases), stable pelvic ring fracture (3 cases), APC (5 cases), LC (7 cases), VS (1 case), acetabular fracture (6 cases), and acetabulum + pelvic ring fracture (1 case). The displacement of the fracture site decreased in 3 cases, increased in 6 cases, and remained unchanged in 10 cases.
　　[Conclusion] In many cases, the placement of a pelvic fixation device increased the displacement of the fracture site.

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