{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T13:43:48Z","timestamp":1767015828663,"version":"3.48.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004047","name":"Karolinska Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Orthop Surg Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To analyze penetrating extremity injuries at a Scandinavian urban Level-1 trauma center regarding incidence, mechanism of injury, imaging approach and clinical outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective study (2013\u20132016) of penetrating injuries to the extremities based on a Trauma Registry. Retrieved variables included patient demographics, injury characteristics, time to CT and 30-day morbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 636 patients with penetrating trauma, 142 (22.3%) sustained injuries to the extremities that required imaging, surgical treatment, or observation. Median age was 25\u00a0years (15\u201383) and consisted mostly of males (90.8%, 129\/142). Most were Level-1 trauma, 81.7%, with 28.9% multi trauma. Most common injuries were gunshot wounds (GSW, 47.9%) and stab wounds (SW, 47.2%), and lower extremities were most common (77.8%). Imaging showing arterial injury was present in 31.0%. %. CT-angiography was the most common modality 65.5% (93\/142) and had excellent sensitivity for vascular injury of 100%. More than half of CTAs were negative: 60.4% in GSW compared to 53.7% in SW. GSWs were 7.4-times likelier to necessitate acute surgery compared to SWs (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0001). Surgery requiring vascular repair consisted of 19.0% and was more common in GSW 11.3% compared to SW 6.3%. Fasciotomy was performed in 5.6% of all GSW. In 1.4% there was loss of limb. The 30-day morbidity rate was 16.2%, mortality was 0%. Overall, GSW increased the odds for 30-day complications, compared to SW (Odds-ratio\u2009=\u200914.1,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In a Scandinavian Level-1 Trauma Center, about every fourth to fifth admission for penetrating trauma involved penetrating extremity injuries. GSWs had a significantly higher probability for acute surgery, and higher rate of 30-day complications. The rate of arterial injury was around one third of all injuries. CTA is effective and sensitive in detecting clinically relevant vascular injuries. Half of CTAs were negative. Stratifying patients into exam-based indication for CTA is important to reduce unnecessary imaging.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00590-025-04507-x","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T18:14:25Z","timestamp":1757528065000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Penetrating extremity injuries in a large Scandinavian Level-1 trauma center: a 4-year analysis of imaging methods, mechanisms of injury and clinical outcome"],"prefix":"10.1007","volume":"35","author":[{"given":"Paulina","family":"Cewe","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sigurveig","family":"Thorisdottir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gudrun L.","family":"Oladottir","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor Gabriel","family":"El-Hajj","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor E.","family":"Staartjes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Elmi-Terander","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seppo K.","family":"Koskinen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"Edstr\u00f6m","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"4507_CR1","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1007\/s00068-018-1045-1","volume":"46","author":"PB B\u00e4ckman","year":"2020","unstructured":"B\u00e4ckman PB, Riddez L, Adamsson L, Wahlgren C-M (2020) Epidemiology of firearm injuries in a Scandinavian trauma center. Eur J Trauma Emerg Surg 46:641\u2013647","journal-title":"Eur J Trauma Emerg Surg"},{"key":"4507_CR2","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1007\/s10140-016-1469-z","volume":"24","author":"CG Colip","year":"2017","unstructured":"Colip CG, Gorantla V, LeBedis CA et al (2017) Extremity CTA for penetrating trauma: 10-year experience using a 64-detector row CT scanner. Emerg Radiol 24:223\u2013232","journal-title":"Emerg Radiol"},{"key":"4507_CR3","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1016\/j.injury.2008.02.043","volume":"39","author":"O Doody","year":"2008","unstructured":"Doody O, Given MF, Lyon SM (2008) Extremities-Indications and techniques for treatment of extremity vascular injuries. Injury 39:1295\u20131303","journal-title":"Injury"},{"key":"4507_CR4","doi-asserted-by":"publisher","first-page":"W49","DOI":"10.2214\/AJR.08.2011","volume":"193","author":"MS Gakhal","year":"2009","unstructured":"Gakhal MS, Sartip KA (2009) CT angiography signs of lower extremity vascular trauma. AJR Am J Roentgenol 193:W49-57","journal-title":"AJR Am J Roentgenol"},{"key":"4507_CR5","doi-asserted-by":"publisher","first-page":"1869","DOI":"10.1007\/s00414-019-02033-0","volume":"133","author":"LE Paulis","year":"2019","unstructured":"Paulis LE, Kroll J, Heijnens L et al (2019) Is CT bulletproof? On the use of CT for characterization of bullets in forensic radiology. Int J Legal Med 133:1869\u20131877","journal-title":"Int J Legal Med"},{"key":"4507_CR6","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1007\/s40719-016-0035-1","volume":"2","author":"CM Wahlgren","year":"2016","unstructured":"Wahlgren CM, Riddez L (2016) Penetrating vascular trauma of the upper and lower limbs. Curr Trauma Rep 2:11\u201320","journal-title":"Curr Trauma Rep"},{"key":"4507_CR7","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1007\/s10140-020-01826-w","volume":"28","author":"L Walkoff","year":"2021","unstructured":"Walkoff L, Nagpal P, Khandelwal A (2021) Imaging primer for CT angiography in peripheral vascular trauma. Emerg Radiol 28:143\u2013152","journal-title":"Emerg Radiol"},{"key":"4507_CR8","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1007\/s10140-020-01847-5","volume":"28","author":"K Weger","year":"2021","unstructured":"Weger K, Hammer P, McKinley T, Steenburg S (2021) Incidence and clinical impact of lower extremity vascular injuries in the setting of whole body computed tomography for trauma. Emerg Radiol 28:265\u2013272","journal-title":"Emerg Radiol"},{"key":"4507_CR9","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.surg.2017.09.019","volume":"163","author":"LA Gurien","year":"2018","unstructured":"Gurien LA, Kerwin AJ, Yorkgitis BK et al (2018) Reassessing the utility of CT angiograms in penetrating injuries to the extremities. Surgery 163:419\u2013422","journal-title":"Surgery"},{"key":"4507_CR10","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1007\/s00068-019-01170-w","volume":"47","author":"G Wihlke","year":"2021","unstructured":"Wihlke G, Str\u00f6mmer L, Tro\u00ebng T, Brattstr\u00f6m O (2021) Long-term follow-up of patients treated for traumatic injury regarding physical and psychological function and health-related quality of life. Eur J Trauma Emerg Surg 47:129\u2013135","journal-title":"Eur J Trauma Emerg Surg"},{"key":"4507_CR11","doi-asserted-by":"publisher","first-page":"023","DOI":"10.1055\/s-0037-1612622","volume":"27","author":"C Protack","year":"2018","unstructured":"Protack C, Wengerter B, Jean R et al (2018) Overutilization of cross-sectional imaging in the lower extremity trauma setting. Int J Angiol 27:023\u2013028","journal-title":"Int J Angiol"},{"key":"4507_CR12","first-page":"808","volume":"70","author":"K Inaba","year":"2011","unstructured":"Inaba K, Branco BC, Reddy S et al (2011) Prospective evaluation of multidetector computed tomography for extremity vascular trauma. J Trauma 70:808\u2013815","journal-title":"J Trauma"},{"key":"4507_CR13","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/s13244-020-00947-7","volume":"11","author":"S Wirth","year":"2020","unstructured":"Wirth S, Hebebrand J, Basilico R et al (2020) European society of emergency radiology: guideline on radiological polytrauma imaging and service (short version). Insights Imaging 11:135","journal-title":"Insights Imaging"},{"doi-asserted-by":"crossref","unstructured":"Fishman EK, Horton KM, Johnson KM (2008) Multidetector CT and three-dimensional CT angiography for suspected vascular trauma of the extremities. Radiographics 28 653\u201365 discussion 665\u20136","key":"4507_CR14","DOI":"10.1148\/rg.283075050"},{"key":"4507_CR15","doi-asserted-by":"publisher","DOI":"10.1007\/s40719-016-0035-1","volume-title":"Penetrating vascular trauma of the upper and lower limbs","author":"CM Wahlgren","year":"2016","unstructured":"Wahlgren CM, Riddez L (2016) Penetrating vascular trauma of the upper and lower limbs. Springer International Publishing, Curr Trauma Rep"},{"key":"4507_CR16","doi-asserted-by":"publisher","first-page":"1586","DOI":"10.1007\/s00330-014-3174-1","volume":"24","author":"A Adibi","year":"2014","unstructured":"Adibi A, Krishnam MS, Dissanayake S et al (2014) Computed tomography angiography of lower extremities in the emergency room for evaluation of patients with gunshot wounds. Eur Radiol 24:1586\u20131593","journal-title":"Eur Radiol"},{"issue":"Suppl 1","key":"4507_CR17","doi-asserted-by":"publisher","first-page":"S133","DOI":"10.1148\/rg.25si055511","volume":"25","author":"MM Miller-Thomas","year":"2005","unstructured":"Miller-Thomas MM, West OC, Cohen AM (2005) Diagnosing traumatic arterial injury in the extremities with CT angiography: pearls and pitfalls. Radiographics 25(Suppl 1):S133\u2013S142","journal-title":"Radiographics"},{"key":"4507_CR18","doi-asserted-by":"publisher","first-page":"e030","DOI":"10.1097\/OI9.0000000000000030","volume":"2","author":"AK Callan","year":"2019","unstructured":"Callan AK, Bauer JM, Mir HR (2019) Over-utilization of computed tomography angiography in extremity trauma. OTA Int 2:e030","journal-title":"OTA Int"}],"container-title":["European Journal of Orthopaedic Surgery &amp; Traumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-025-04507-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00590-025-04507-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00590-025-04507-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T13:40:36Z","timestamp":1767015636000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00590-025-04507-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,10]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4507"],"URL":"https:\/\/doi.org\/10.1007\/s00590-025-04507-x","relation":{},"ISSN":["1432-1068"],"issn-type":[{"type":"electronic","value":"1432-1068"}],"subject":[],"published":{"date-parts":[[2025,9,10]]},"assertion":[{"value":"10 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The Institutional Review Board (2017\/1018-31\/2) waived the need for informed consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The study was approved by the Institutional Review Board (2017\/1018-31\/2).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}],"article-number":"389"}}