{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T14:17:56Z","timestamp":1778249876365,"version":"3.51.4"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Polytrauma represents a critical emergency condition characterized by complex treatment challenges and multiple complications, constituting one of the primary causes of mortality from accidental injuries. Severe polytrauma typically results from high-energy impacts, with traffic accidents, falls from height, and other fall-related injuries being the predominant causes. Without prompt and appropriate intervention, mortality rates range from 20 to 70%. The combination of polytrauma, traumatic diaphragmatic hernia, and pelvic-acetabular fractures complicates clinical management, prolongs treatment duration, and leads to significantly elevated mortality and disability rates. This case underscores the critical importance of integrating standardized clinical trauma treatment protocols with robot-assisted minimally invasive surgery to enhance patient survival rates and promote early functional recovery.<\/jats:p>","DOI":"10.3389\/fmed.2026.1722340","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T10:15:07Z","timestamp":1773828907000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Minimally invasive treatment for critical multiple trauma with traumatic diaphragmatic hernia combined with pelvic and acetabular fractures: a rare case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Meng-Fei","family":"Zhou","sequence":"first","affiliation":[{"name":"Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeng-Ying","family":"Xing","sequence":"additional","affiliation":[{"name":"Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ri-Jin","family":"Xing","sequence":"additional","affiliation":[{"name":"Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tian-Yang","family":"Li","sequence":"additional","affiliation":[{"name":"Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bi-Gang","family":"Li","sequence":"additional","affiliation":[{"name":"Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Liu","sequence":"additional","affiliation":[{"name":"Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yun-Yun","family":"Wu","sequence":"additional","affiliation":[{"name":"Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Xiong","sequence":"additional","affiliation":[{"name":"Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University","place":["Haikou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"ref1","first-page":"403","article-title":"Research progress in the treatment of severe multiple injuries","volume":"59","author":"Guo","year":"2016","journal-title":"Peoples Military Surgeon"},{"key":"ref2","first-page":"481","article-title":"Consensus on the diagnosis and treatment of limb fractures combined with thoracoabdominal injuries","volume":"18","author":"Lin","year":"2025","journal-title":"Zhongguo Gu Shang"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1007\/s00402-020-03499-z","article-title":"Pelvic and acetabular fracture management in intravenous drug users","volume":"141","author":"Orfanos","year":"2021","journal-title":"Arch Orthop Trauma Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1097\/BOT.0b013e3181ca32af","article-title":"Combined injuries of the pelvis and acetabulum: nature of a devastating dyad","volume":"24","author":"Suzuki","year":"2010","journal-title":"J Orthop Trauma"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e919442","DOI":"10.12659\/AJCR.919442","article-title":"Traumatic diaphragmatic rupture with transthoracic organ herniation: a case report and review of literature","volume":"21","author":"Shaban","year":"2020","journal-title":"Am J Case Rep"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1097\/BOT.0b013e31826c2751","article-title":"Combined pelvic ring disruption and acetabular fracture: associated injury patterns in 40 patients","volume":"27","author":"Osgood","year":"2013","journal-title":"J Orthop Trauma"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e53","DOI":"10.1097\/TA.0000000000002407","article-title":"Orthopedic injuries in patients with multiple injuries: results of the 11th trauma update international consensus conference Milan, December 11, 2017","volume":"88","author":"Cimbanassi","year":"2020","journal-title":"J Trauma Acute Care Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1803","DOI":"10.1007\/s00264-017-3532-0","article-title":"Surgical treatment of unstable pelvic fractures with concomitant acetabular fractures","volume":"41","author":"Cai","year":"2017","journal-title":"Int Orthop"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"493","DOI":"10.55095\/achot2012\/071","article-title":"Pelvic ring injuries in children. Part I: epidemiology and primary evaluation. A review of the literature","volume":"79","author":"G\u00e4nsslen","year":"2012","journal-title":"Acta Chir Orthop Traumatol Czech"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"304","DOI":"10.5435\/JAAOS-22-05-304","article-title":"Combined acetabulum and pelvic ring injuries","volume":"22","author":"Halvorson","year":"2014","journal-title":"J Am Acad Orthop Surg"},{"key":"ref11","first-page":"91","article-title":"Pelvic fracture in the patient with multiple injuries: factors and lesions associated with mortality","volume":"30","author":"Mart\u00ednez","year":"2018","journal-title":"Emergencias"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1677","DOI":"10.1007\/s00264-023-05828-4","article-title":"Surgical load in major fractures \u2013 results of a survey on the optimal quan tification and timing of surgery in polytraumatized patients","volume":"47","author":"Klingebiel","year":"2023","journal-title":"Int Orthop"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"667","DOI":"10.5435\/JAAOS-D-15-00181","article-title":"The Morel-Lavalle\u2019e lesion: diagnosis and management","volume":"24","author":"Scolaro","year":"2016","journal-title":"J Am Acad Orthop Surg"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"76","DOI":"10.23750\/abm.v90i12-S.8949","article-title":"Pelvic ring fractures: what about timing?","volume":"90","author":"Artoni","year":"2019","journal-title":"Acta Biomed"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1016\/j.injury.2017.12.007","article-title":"The prevalence and morphology of the corona mortis (crown of death): a meta-analysis with implications in abdominal wall and pelvic surgery","volume":"49","author":"Sanna","year":"2018","journal-title":"Injury"},{"key":"ref16","first-page":"274","article-title":"Inguinal abnormalities in male patients with acetabular fractures treated using an ilioinguinal exposure","volume":"3","author":"Firoozabadi","year":"2015","journal-title":"Arch Bone Jt Surg"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1016\/j.injury.2021.09.040","article-title":"Exposing the incidence of ileus in pelvic and acetabular fractures: a retrospective case analysis","volume":"53","author":"Ward","year":"2022","journal-title":"Injury"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e0222","DOI":"10.2106\/JBJS.CC.18.00222","article-title":"Small bowel obstruction secondary to entrapment in a minimally displaced acetabular fracture: a case report","volume":"9","author":"Westberg","year":"2019","journal-title":"JBJS Case Connect"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s00590-021-02944-y","article-title":"Genitourinary complications in orthopaedic surgery","volume":"32","author":"Testa","year":"2022","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1097\/BOT.0000000000001159","article-title":"Sarcopenia is predictive of 1-year mortality after acetabular fractures in elderly patients","volume":"32","author":"Mitchell","year":"2018","journal-title":"J Orthop Trauma"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e706","DOI":"10.5435\/JAAOS-D-23-00190","article-title":"Imaging of pelvic and acetabular trauma: part 2, soft-tissue findings","volume":"31","author":"Eastman","year":"2023","journal-title":"J Am Acad Orthop Surg"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1136\/heartjnl-2020-318661","article-title":"National Institute for health and care excellence clinical guidelines development principles and processes","volume":"107","author":"Garbi","year":"2021","journal-title":"Heart"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s13017-017-0117-6","article-title":"Pelvic trauma: WSES classification and guidelines","volume":"12","author":"Coccolini","year":"2017","journal-title":"World J Emerg Surg"},{"key":"ref24","first-page":"1252-1255+1263","article-title":"Interpretation of multiple trauma medical records and diagnosis: expert consensus (2023 Edition)","volume":"35","author":"Li","year":"2023","journal-title":"Med J West China"},{"key":"ref25","first-page":"04","article-title":"Trauma orthopaedics group of Orthopaedic Branch of Chinese Medical Association, External Fixation and Limb Reconstruction Group of Orthopaedic Branch of Chinese Medical Association, Traumatology Branch of Chinese Medical Association, National Clinical Medical Research Center for Orthopaedics and Sports Rehabilitation","volume":"23","author":"Hua","year":"2021","journal-title":"Chin. J. Ortho. Trauma"},{"key":"ref26","first-page":"123","article-title":"A case report of teleremote treatment of tile type C1.3 pelvic ring injury via trauma orthopaedic telerobotic surgical system","volume":"39","author":"He","year":"2025","journal-title":"Chin J Repar Reconstr Surg"},{"key":"ref27","first-page":"1308","article-title":"Pelvic unlocking reduction frame combined with intelligent visualization system for assisted reduction and fixation in the treatment of tile type C1 pelvic fractures","volume":"43","author":"He","year":"2023","journal-title":"Chin J Orthop"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1302\/0301-620X.71B2.2925751","article-title":"Grading the outcome of pelvic fractures","volume":"71","author":"Majeed","year":"1989","journal-title":"J Bone Joint Surg Br"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"737","DOI":"10.2106\/00004623-196951040-00012","article-title":"Traumatic arthritis of the hip after dislocation and acetabular fractures;treatment by mold arthroplasty","volume":"51","author":"Harris","year":"1969","journal-title":"J Bone Joint Surg Am"},{"key":"ref30","first-page":"1327","article-title":"Multi-center study on unstable pelvic ring injuries treated with pelvic reduction and fixation device","volume":"36","author":"Chen","year":"2022","journal-title":"Chin J Reparative Reconstruct Surg"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"3317","DOI":"10.1111\/os.13874","article-title":"A new technology using mixed reality surgical navigation with the unlocking closed reduction technique frame to assist pelvic fracture reduction and fixation: technical note","volume":"15","author":"Li","year":"2023","journal-title":"Orthop Surg"},{"key":"ref32","first-page":"1049","article-title":"Early clinical study on computer navigation-assisted sacroiliac percutaneous screw fixation for pelvic ring injuries","volume":"37","author":"Cao","year":"2023","journal-title":"Chin J Reparative Reconstruct Surg"},{"key":"ref33","first-page":"129","article-title":"A comparative study on the application effect of 3D visualization technology without transparency and 2D perspective in the reduction of unstable pelvic fractures","volume":"37","author":"Li","year":"2023","journal-title":"Chin J Reparative Reconstruct Surg"},{"key":"ref34","first-page":"696","article-title":"Clinical study of a dual-window screw insertion for acetabular fractures assisted by HoloSight trauma orthopedic surgical robot","volume":"38","author":"Cao","year":"2024","journal-title":"Chin J Reparative Reconstruct Surg"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1016\/j.amjsurg.2014.12.023","article-title":"Traumatic diaphragmatic injury in the American College of Surgeons National Trauma Data Bank: a new examination of a rare diagnosis","volume":"209","author":"Fair","year":"2015","journal-title":"Am J Surg"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e91424","DOI":"10.7759\/cureus.91424","article-title":"Delayed traumatic diaphragmatic hernias: tomorrow\u2019s emergency","volume":"17","author":"Giangrosso","year":"2025","journal-title":"Cureus"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1097\/TA.0000000000004554","article-title":"The diagnosis and management of acute traumatic diaphragmatic injury: a Western trauma association clinical decisions algorithm","volume":"98","author":"Schellenberg","year":"2025","journal-title":"J Trauma Acute Care Surg"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"6562","DOI":"10.3390\/jcm14186562","article-title":"Clinical indicators and imaging characteristics of blunt traumatic diaphragmatic injury: a retrospective single-center study","volume":"14","author":"Ryu","year":"2025","journal-title":"J Clin Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"e0226364","DOI":"10.1371\/journal.pone.0226364","article-title":"Acute and chronic traumatic diaphragmatic hernia: 10 years\u2019 experience","volume":"14","author":"Gu","year":"2019","journal-title":"PLoS One"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1148\/rg.230110","article-title":"Approach to acute traumatic and non-traumatic diaphragmatic abnormalities","volume":"44","author":"Keyes","year":"2024","journal-title":"Radiographics"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s13017-023-00510-x","article-title":"Management of complicated diaphragmatic hernia in the acute setting: a WSES position paper","volume":"18","author":"Giuffrida","year":"2023","journal-title":"World J Emerg Surg"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2016\/6723632","article-title":"Fractured ribs and the CT funky fat sign of diaphragmatic rupture","volume":"2016","author":"Ocak","year":"2016","journal-title":"Case Rep Radiol"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1016\/j.ijscr.2013.03.027","article-title":"Delayed post-traumatic diaphragmatic rupture complicated by total hepato-thorax: a case report","volume":"4","author":"Kastanakis","year":"2013","journal-title":"Int J Surg Case Rep"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"56","DOI":"10.17116\/hirurgia201904156","article-title":"Lechenie gigantsko\u012d posttravmatichesko\u012d diafragmal'no\u012d gryzhi cherez 17 let posle razryva grudobriushno\u012d pregrady","volume":"4","author":"Parshin","year":"2019","journal-title":"Khirurgiia"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/s13017-025-00607-5","article-title":"A China-based exploration of surgical timing for polytrauma with a focus on fracture reconstruction","volume":"20","author":"Ding","year":"2025","journal-title":"World J Emerg Surg"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1111\/os.12452","article-title":"Guidance for treatment of pelvic acetabular injuries with precise minimally invasive in-ternal fixation based on the orthopaedic surgery robot posi-tioning system","volume":"11","author":"Wu","year":"2019","journal-title":"Orthop Surg"},{"key":"ref47","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s13020-021-00512-4","article-title":"Review on clinical application of orthopaedic surgical robots","volume":"42","author":"Zhang","year":"2021","journal-title":"Chin Med Equip J"},{"key":"ref48","first-page":"90","article-title":"Application status and research progress of orthopaedic robots","volume":"58","author":"Cai","year":"2018","journal-title":"Shandong Med J"},{"key":"ref49","first-page":"1021","article-title":"Clinical study on orthopaedic robot-assisted minimally invasive surgery for acetabular fractures","volume":"22","author":"Zhao","year":"2020","journal-title":"Chin J Orthop Trauma"},{"key":"ref50","first-page":"1049","article-title":"Early clinical study on computer navigation system-assisted sacroiliac transfixion screw implantation in the treatment of posterior pelvic ring injuries","volume":"37","author":"Cao","year":"2023","journal-title":"Chin J Repar Reconstruct Surg"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1016\/j.injury.2022.11.001","article-title":"Intelligent robot-assisted minimally invasive reduction system for reduction of unstable pelvic fractures","volume":"54","author":"Zhao","year":"2023","journal-title":"Injury"},{"key":"ref52","first-page":"1285","article-title":"Efficacy of robot-assisted placement of infra-acetabular screws in the treatment of acetabular fractures","volume":"43","author":"Xue","year":"2023","journal-title":"Chin J Orthop"},{"key":"ref53","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/scientificamerican0883-28","article-title":"Accidental and intentional injury account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are proven preventive efforts, specialized surgery and further research","volume":"249","author":"Trunkey","year":"1983","journal-title":"Sci Am"},{"key":"ref54","first-page":"377","article-title":"Research progress in orthopaedic robot-navigated surgery","volume":"35","author":"Li","year":"2019","journal-title":"Chin J Traumatol"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"292","DOI":"10.1001\/jamasurg.2016.4952","article-title":"Enhanced recovery after surgery: a review","volume":"152","author":"Ljungqvist","year":"2017","journal-title":"JAMA Surg"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1001\/jamasurg.2021.0586","article-title":"Opportunities and challenges for the next phaseof enhanced recovery after surgery a review","volume":"56","author":"Ljungqvist","year":"2021","journal-title":"JAMA Surg"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"121","DOI":"10.2217\/cer-2021-0258","article-title":"Early mobilization in enhanced recovery after surgery pathways: current evidence and recent advancements","volume":"11","author":"Tazreean","year":"2022","journal-title":"J Comp Eff Res"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1002\/bjs5.50238","article-title":"Recommendations from the ERAS society for standards for the development of enhanced recovery after surgery guidelines","volume":"4","author":"Brindle","year":"2019","journal-title":"BJS Open"},{"key":"ref59","first-page":"123","article-title":"A case of remote treatment of tile C1.3 pelvic ring injury using a teleoperated surgical robot system in trauma orthopedics","volume":"39","author":"He","year":"2025","journal-title":"Chin J Reparative Reconstruct Surg"}],"updated-by":[{"DOI":"10.3389\/fmed.2026.1856627","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000}}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1722340\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T13:59:51Z","timestamp":1778248791000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1722340\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,3]]},"references-count":59,"alternative-id":["10.3389\/fmed.2026.1722340"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1722340","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,3]]},"article-number":"1722340"}}