Migration of orthopedic screws into the bladder is a rare postoperative complication following surgical fixation of pelvic fractures. We present a case of a 61-year-old man who sustained a type 3 anteroposterior compression injury with pubic symphysis diastasis, left sacroiliac joint dislocation, and lumbar spine transverse process fracture. At the time of presentation open-reduction internal fixation of his pubic symphysis and closed-reduction percutaneous screw fixation of the left sacroiliac joint was performed. At his 6 month post operative visit, the patient was seen for follow up and reported mild pelvic pain and new urinary symptoms, including hematuria and recurrent urinary tract infections, which lead to further investigation. Imaging revealed findings concerning for migration of one of the pubic symphysis screws with bladder involvement. Cystoscopy confirmed the presence of a foreign body in the bladder. The patient subsequently underwent removal of the pelvic hardware, definitive bladder repair and left sacroiliac arthrodesis, followed by an uneventful postoperative course. This report describes the delayed presentation of spontaneous screw migration after repair of an open book pelvic fracture and describes the diagnostic and management considerations for patients with urinary symptoms after pubic symphysis open reduction internal fixation.

Limb-length discrepancy following lower-extremity trauma significantly affects patients' functioning and quality of life and is generally avoided by anatomical reconstruction. When lower-extremity trauma is accompanied by tibial-nerve injury, standard treatment protocols may require modifications. We describe a 38-year-old Japanese man with a Gustilo type IIIB open tibial-shaft fracture and complete tibial-nerve rupture, which we treated with acute shortening and gradual lengthening (ASGL). The tibia was shortened by 40 mm to facilitate the tibial nerve's direct end-to-end neurorrhaphy at a healthy site. Initial stabilization was achieved using an external fixator, followed by staged internal fixation and soft-tissue reconstruction with a free latissimus dorsi flap. Once flap integration was confirmed, gradual lengthening with an Ilizarov external fixator restored the limb length, with no length discrepancy. Two years post-injury, the patient regained protective plantar sensation and full weight-bearing ability. He achieved advanced functional milestones: a single-leg stance and hopping. Electromyography (EMG) confirmed the intrinsic foot-muscle reinnervation, including the abductor hallucis and interosseous muscles. The patient resumed snowboarding. This case demonstrates that ASGL has advantages for skeletal and soft-tissue reconstruction and nerve recovery optimization. Although nerve grafting can restore sensation, motor recovery is often limited. In young patients with a complete tibial nerve rupture, tibial shortening to allow direct primary repair may provide superior functional outcomes in both sensory and motor domains. This appears to be the first documentation by EMG of the functional recovery of intrinsic foot muscles following tibial-nerve repair.

Traumatic diaphragmatic hernia (TDH) is an uncommon condition resulting from high-energy blunt trauma or penetrating injuries. Right-sided TDH accounts for a small proportion of diaphragmatic ruptures. Early diagnosis remains a major challenge, with a significant number of cases diagnosed late, which increases morbidity and mortality by a substantial increase. Computed tomography (CT), particularly for right-sided TDH, is a diagnostic modality with high sensitivity and specificity. We report two cases of right-sided TDH with hepatic herniation following blunt trauma. The first case involved a 30-year-old male who sustained high-energy trauma in a motor vehicle collision. Hemodynamically stable, he underwent CT imaging that confirmed the diagnosis. He was treated via laparotomy with surgical repair and had a prolonged ICU stay due to rhabdomyolysis and pneumonia, ultimately discharged in good condition. The second case involved a 72-year-old female pedestrian struck by a bus. She also presented hemodynamically stable, underwent CT, and received early surgical repair via laparotomy. She was discharged on postoperative day three with favorable recovery. These cases highlight the importance of high clinical suspicion based on trauma mechanism, the role of CT in stable patients, and the value of early diagnosis and surgical management in achieving favorable outcomes. At one-year follow-up, the patient remained asymptomatic, with no recurrence or functional respiratory limitations on clinical examination.