Purpose Penetrating thoracic trauma is a major cause of morbidity and mortality in the Northern Territory (NT), where remote geography creates trauma system challenges. This study describes epidemiology, injury patterns, management, outcomes, and vascular injury burden of penetrating thoracic trauma at the NT Major Trauma Centre (NT MTC). Methodology A retrospective cohort study used the Trauma Registry. Adults admitted with penetrating thoracic trauma between 1 January 2020 and 31 December 2025 were included. Demographics, injury patterns, thoracic AIS severity, management, vascular injuries, and outcomes were analysed descriptively. Results 201 patients included; superficial breast injuries excluded. Median age was 33 years; 141 (70%) were male and 170 (85%) Aboriginal and Torres Strait Islander. Assault accounted for 177 (88%), with 148 (74%) presenting after hours. Median ISS was 5, and 38 (19%) sustained major trauma (ISS >13). Thoracic injury severity was minor in 75 (37%), moderate in 47 (23%), serious in 59 (30%), severe in 10 (5%), and critical in 10 (5%). Common injuries were pneumothorax (65), haemopneumothorax (36), lung laceration/contusion (28), and haemothorax (15). Major thoracic vascular injury occurred in seven patients, including six arterial injuries. Although uncommon, these were associated with severe injury patterns and rapid deterioration. Cardiac injury occurred in six patients, all critical. Overall in-hospital mortality was 2.5% (5/201), rising to 20% in critical injuries. Conclusion Penetrating thoracic trauma at NT MTC predominantly affects young Aboriginal and Torres Strait Islander men and is overwhelmingly assault-related. While most injuries are minor to moderate, a small but important subgroup sustains major vascular and cardiac injuries associated with significant morbidity and mortality. This data provides a contemporary benchmark for penetrating thoracic trauma in the NT and support development of dedicated thoracic trauma pathways.