Injury to the Trunk (Torso Trauma)

What to do right after a trunk injury

1. Check for danger signs listed above. If any are present, call 911 or your local emergency number.
2. Do not move someone with a possible back or neck injury unless they are in danger. Keep them still and warm.
3. For bleeding wounds, press firmly with a clean cloth. Do not remove any object that is stuck in the body; pad around it.
4. For an open chest wound that bubbles or sucks air, cover it with a dressing and keep the person still and supported. Emergency dispatchers can advise.
5. Do not give food or drink in case surgery is needed.
6. After a minor blow, rest, apply a cold pack wrapped in cloth for 15 to 20 minutes, and watch for warning signs over the next 24 to 48 hours.

Types of trunk injury

Doctors divide trunk trauma into blunt injuries (crashes, falls, blows, crushing) and penetrating injuries (stab wounds, gunshots, impalement). Blunt injuries are more common and harder to judge from the outside.

Chest injuries

• Bruised or broken ribs: sharp pain on breathing, coughing or twisting, and local tenderness. See rib fracture.
• Flail chest: several ribs broken in more than one place, so a segment of chest wall moves in the wrong direction with breathing.
• Pneumothorax: air leaks into the space around the lung, which collapses. Causes sudden breathlessness and chest pain.
• Hemothorax: blood collects around the lung.
• Lung and heart contusion: bruising of the organs, which can affect oxygen levels or heart rhythm.
• Cardiac tamponade: blood around the heart prevents it filling, an immediate emergency.

Abdominal injuries

• Spleen and liver injuries: the most commonly injured organs in blunt trauma. They bleed internally, causing belly pain, sometimes left or right shoulder-tip pain, and signs of shock. See spleen injury.
• Bowel injury: often from a lap seat belt; pain and fever can develop over a day or two as contents leak.
• Kidney injury: from blows to the back or flank, often with blood in the urine.
• Pancreas and diaphragm injuries: less common and easy to miss early.

Back and spine injuries

Muscle strains and bruises are common. Fractures of the vertebrae can follow falls and crashes, and in older adults with osteoporosis even minor falls. Fractures can injure the spinal cord, causing numbness, weakness or loss of bladder control.

Pelvic injuries

Pelvic fractures from high-energy trauma can bleed heavily and injure the bladder and urethra.

Symptoms of a trunk injury

• Pain, tenderness and bruising, including seat-belt marks across the chest or abdomen
• Pain on breathing, coughing or moving
• Shortness of breath or fast breathing
• Belly pain, swelling, nausea or vomiting
• Blood in urine, vomit or stool
• Signs of shock from internal bleeding: dizziness, thirst, pale cold skin, fast weak pulse, confusion
• Numbness, tingling or weakness in the legs after a back injury

Symptoms can be delayed. A spleen can bleed slowly, and bowel injuries may not show for 12 to 24 hours.

How doctors diagnose trunk injuries

Trauma teams follow a structured approach: airway, breathing, circulation, then a head-to-toe check. Tests include:

• FAST scan: a quick bedside ultrasound looking for blood around the heart, lungs, liver, spleen and in the pelvis.
• Chest X-ray: for rib fractures, pneumothorax and hemothorax.
• CT scan with contrast: the main test for organ injuries, spinal fractures and bleeding in stable patients.
• Blood tests: blood count, liver and pancreatic enzymes, blood group for transfusion.
• Urine test: for blood that suggests kidney or bladder injury.
• ECG: if a heart contusion is possible.

Treatment

Minor injuries

Bruises, muscle strains and simple rib fractures are treated with pain relief, such as acetaminophen (paracetamol) or ibuprofen at the label dose, ice in the first 48 hours, and gentle activity. With rib injuries, deep breaths and coughing every hour while awake, holding a pillow against the chest, help prevent pneumonia. Rib fractures usually heal in about 6 weeks.

Serious injuries

• Chest drain to remove air or blood around the lung.
• Blood transfusion and fluids for bleeding.
• Observation in hospital for many spleen, liver and kidney injuries, which often stop bleeding on their own.
• Embolization: a radiologist blocks a bleeding artery through a catheter.
• Surgery for uncontrolled bleeding, bowel perforation, diaphragm tears or unstable spinal fractures.
• Spinal immobilization and surgery for unstable spinal injuries.

Complications

Possible complications include pneumonia after rib fractures, delayed rupture of a spleen, infection from bowel injury, chronic pain, and long-term disability after spinal cord injury. People who have had a spleen removed need extra vaccines and prompt treatment for fevers.

Frequently asked questions

What counts as the trunk of the body?

The trunk, or torso, is the central part of the body excluding the head, neck, arms and legs. It includes the chest, abdomen, back, flanks and pelvis, and holds the heart, lungs, liver, spleen, kidneys, bowel and spine.

Can you have internal bleeding without bruising?

Yes. Serious bleeding from the spleen, liver or kidneys can happen with little or no bruising on the skin. Warning signs are worsening belly or back pain, dizziness, fainting, thirst, pale clammy skin and a fast pulse. Get emergency care if these appear after an injury.

How long does a trunk injury take to heal?

Bruises and strains heal in 1 to 3 weeks. Rib fractures take about 6 weeks. Organ injuries managed without surgery usually need several weeks of reduced activity, and contact sports are avoided for longer. Spinal and major injuries can take months.

When should I go to the ER after a fall or crash?

Go after any high-speed crash, a fall from height, or a blow followed by breathing difficulty, worsening chest, belly or back pain, dizziness, blood in urine, or leg numbness or weakness. Older adults and people on blood thinners should be checked even after minor falls.