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The Extremities

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Trauma Computed Tomography

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Abstract

Extremity trauma is a multisystem injury, which can involve soft tissues, osseous structures, vasculature, and nerves. Severe open extremity fractures can be potentially devastating, necessitating amputation, while less severe injuries may require staged osseous repair with vascular or soft tissue reconstruction. Following treatment, these injuries may require debridements and revisions due to nonunion or infection. While the assessment of extremity injuries typically begins with radiographs, CTA is often a necessary next step to evaluate regional vasculature and to assess for injuries that may be amenable to or require surgical or endovascular intervention. An extremity CTA is often performed as part of an admission whole-body CT workup in patients with extremity trauma utilizing a single contrast bolus. Post-operative complications such as vascular patency and infection are readily assessed on follow-up CT.

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Abbreviations

3D:

Three-dimensional

ABI:

Ankle-brachial index

API:

Arterial pressure index

AVF:

Arteriovenous fistula

AVN:

Avascular necrosis

CPR:

Curved planar reformats

CT:

Computed tomography

CTA:

Computed tomography angiography

DSA:

Digital subtraction angiogram

MIP:

Maximum intensity projection

MPR:

Multiplanar reformat

MRI:

Magnetic resonance imaging

ORIF:

Open reduction and internal fixation

PTFE:

Polytetrafluoroethylene

TVS:

Temporary vascular shunt

VR:

Volume rendering

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Disclosure Statement

The authors have nothing to disclose.

Author information

Authors and Affiliations

  1. Trauma and Emergency Radiology, Department of Diagnostic Radiology and Nuclear Medicine, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA

    Elana B. Smith & David Dreizin

  2. Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Kyle Costenbader

Authors
  1. Elana B. Smith
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  2. Kyle Costenbader
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  3. David Dreizin
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Corresponding author

Correspondence to Elana B. Smith .

Editor information

Editors and Affiliations

  1. Department of Medical Imaging, Penn Presbyterian Medical Center, Philadelphia, PA, USA

    Friedrich Knollmann

Trauma CT Protocols

Trauma CT Protocols

Protocol name

CTA upper extremity

Indication

Vascular injury

Protocol designed for (scanner model)

Siemens Somatom Force

Patient preparation

None

First series

 

Oral contrast

None

IV contrast

100 mL iohexol 350

Tube settings

 

kV

100 kVp

mA

200 mAs

Dose modulation

Yes

Tube rotation time (s)

0.5 s

Table speed (mm/s)

118.5 mm/s

Slice collimation

128 × 0.6

Reconstructed slice thickness

2 mm/1 mm

Anatomical coverage

Thoracic inlet to finger tips

Reconstruction kernel

BV40

Breath hold

None

Window settings

W360/L60

Post-processing

Coronal and sagittal MIPS 5 mm/2 mm

Protocol name

CTA lower extremity

Indication

Vascular injury

Protocol designed for (scanner model)

Siemens Somatom Force

Patient preparation

None

First series

 

Oral contrast

None

IV contrast

100 mL iohexol 350

Tube settings

 

kV

100 kVp

mA

230 mAs

Dose modulation

Yes

Tube rotation time (s)

0.5 s

Table speed (mm/s)

216 mm/s

Slice collimation

128 × 0.6

Reconstructed slice thickness

2 mm/1 mm

Anatomical coverage

Diaphragm to toes

Reconstruction kernel

BV36

Breath hold

Stop breathing

Window settings

W360/L60

Post-processing

Coronal and sagittal MIPS 2 mm/2 mm

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© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

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Smith, E.B., Costenbader, K., Dreizin, D. (2023). The Extremities. In: Knollmann, F. (eds) Trauma Computed Tomography. Springer, Cham. https://doi.org/10.1007/978-3-031-45746-3_11

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  • DOI: https://doi.org/10.1007/978-3-031-45746-3_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-45745-6

  • Online ISBN: 978-3-031-45746-3

  • eBook Packages: MedicineMedicine (R0)

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