Trauma Care, Volume 5, Issue 3 (September 2025) – 5 articles

Background: Rib fractures are among the most common thoracic injuries following blunt trauma and are associated with significant morbidity, particularly in elderly and polytrauma populations. Historically managed non-operatively, recent advances have redefined the role of surgical stabilization of rib fractures (SSRF) in improving patient outcomes. The objective of this narrative review is to evaluate current evidence surrounding the management of rib fractures, with a focus on indications for SSRF, surgical techniques, special populations, and future directions in care. Methods: A narrative review of the literature was conducted, incorporating relevant randomized controlled trials, cohort studies, clinical guidelines, and expert consensus statements. Emphasis was placed on patient selection criteria, surgical strategies, multimodal analgesia, and emerging technologies. Results: SSRF has demonstrated benefits in short- and long-term outcomes, including improved pain control, reduced ventilator dependence, shorter ICU and hospital stays, and better functional recovery. These outcomes are most evident in patients with flail chest, severe displacement, or failure of conservative therapy. Minimally invasive techniques and 3D-printed implants represent promising innovations. Despite growing evidence, SSRF remains underutilized due to variability in institutional protocols and access to trained personnel. Conclusions: The management of rib fractures continues to evolve with increasing support for surgical intervention in select patients. Wider implementation of SSRF, guided by standardized protocols and advanced technologies, may improve outcomes and reduce complications in this high-risk trauma population. Full article

Background/Objectives: This study examines the academic discourse surrounding Critical Incident Stress Debriefing (CISD) and Critical Incident Stress Management (CISM) for first responders using Latent Dirichlet Allocation (LDA) topic modeling. It aims to uncover latent topical structures in the literature and critically evaluate assumptions to identify gaps and limitations. Methods: A corpus of 214 research article abstracts related to CISD/M was gathered from the Web of Science Core Collection. After preprocessing, we used Orange Data Mining software’s LDA tool to analyze the corpus. We tested models ranging from 2 to 10 topics. To guide interpretation and labeling, we evaluated them using log perplexity, topic coherence, and LDAvis visualizations. A four-topic model offered the best balance of detail and interpretability. Results: Four topics emerged: (1) Critical Incident Stress Management in medical and emergency settings, (2) psychological and group-based interventions for PTSD and trauma, (3) peer support and experiences of emergency and military personnel, and (4) mental health interventions for first responders. Key gaps included limited focus on cumulative trauma, insufficient longitudinal research, and variability in procedural adherence affecting outcomes. Conclusions: The findings highlight the need for CISD/M protocols to move beyond event-specific interventions and address cumulative stressors. Recommendations include incorporating holistic, proactive mental health strategies and conducting longitudinal studies to evaluate long-term effectiveness. These insights can help refine CISD/M approaches and enhance their impact on first responders working in high-stress environments. Full article

This case report describes index pancreatoduodenectomy in a 32-year-old male following a close-range gunshot wound to the abdomen, with consequent 4 cm pancreatic head defect, duodenal and common bile duct perforation, right kidney laceration, and through-and-through inferior vena cava (IVC) injury. Although standard trauma protocols often favor damage control surgery (DCS) with delayed reconstruction in unstable patients, this patient’s hemodynamic stability—attributed to retroperitoneal self-tamponade—enabled a single-stage definitive approach. The rationale for immediate reconstruction was to prevent the risks associated with delayed management, such as ongoing pancreatic and biliary leakage, chemical peritonitis, and subsequent sepsis or hemorrhage. This case highlights that, in select stable patients with severe pancreaticoduodenal trauma, immediate pancreatoduodenectomy may be preferable to DCS, provided care is delivered in a high-volume hepatopancreaticobiliary (HPB) center with appropriate expertise and resources. Full article

Background: Liver trauma is prevalent following blunt and penetrating injuries. This study examined liver trauma in a South African urban trauma centre, focusing on the unique prevalence of penetrating injuries and surgical interventions. Methods: A retrospective analysis was conducted of 512 priority-one patients with liver trauma from January 2017 to December 2023 at Charlotte Maxeke Johannesburg Academic Hospital. The data collected included demographics, injury mechanisms, liver injury grades, associated injuries, injury severity scores (ISS and NISS), surgical interventions, and mortality rates. Statistical analyses were performed using Stata (V.18) and R software (version 4.3.2). Results: The median age of the patients was 31 years, with a predominance of male patients (91%) and patients of African ethnicity (95%). Penetrating trauma accounted for 73% of the cases. Most liver injuries were minor (grades I–III). There was a 5% overall mortality rate, with a higher rate observed in patients requiring emergency surgery (10% vs. 1% for non-operative management, p < 0.001). Just over half of the patients required emergency laparotomy, and the majority of these patients sustained penetrating liver trauma. Complications occurred in 6.6% of the patients, predominantly biliary in nature. Conclusions: This study highlights the high incidence of penetrating liver trauma in South Africa, which reflects the context of interpersonal violence. The mortality rate aligns with international standards and demonstrates the need for effective management strategies. These findings emphasise the need for tailored approaches to liver trauma based on injury patterns and demographics, and further research is needed to explore the associated mortality and complications. Full article

Background: Occupational therapists assess cognitive function in patients with traumatic brain injury (TBI) to determine the impact of impairments on occupational performance. In acute care settings, occupational therapists’ decision-making regarding the assessment of cognitive function is influenced by multiple factors. Aims: The aims of this study were to explore the perceived influences on choice of cognitive assessment by occupational therapists, the ways in which they incorporate observation of occupational performance in assessment, and their attitudes towards and experiences of implementing performance-based testing (PBT) in acute care. Methods: Fifteen occupational therapists with an average of 16.5 years of clinical experience working in acute care TBI management participated in an individual semi-structured interview. The interviews were conducted in person or online and consisted of six questions about which cognitive assessments they use in acute care, influences on this choice, and their experiences of assessing functional cognition using performance-based testing. Data were analysed using interpretive description. Results: The final four themes included (1) an emphasis on ‘functional observation of occupational performance’ and use of structured and tailored processes to make assessments, (2) ‘individualised and efficient’ assessment methods, (3) contextual influences on assessment choice, including the ‘occupational therapy department culture and hospital context’, and (4) ‘safety and management of risks’. Conclusions: Occupational therapy assessment of functional cognition in acute care depends on comprehensive understanding of individual patient-specific factors. Therapists are influenced by pragmatic factors when choosing assessments, which has led to the modification of standardised tests drawn from occupation-based approaches to fit within the time constraints of the acute care setting. The results indicate that therapists may benefit from guidance on how to safely assess patients’ functional cognition in an individualised way in the acute care setting. Full article