Near-Infrared Spectroscopy in Lower Extremity Trauma

• Published in: Journal of bone and joint surgery. American volume 2009-06, Vol.91 (6), p.1360-1368
• Main Authors: Shuler, Michael S, Reisman, William M, Whitesides, Thomas E, Kinsey, Tracy L, Hammerberg, E Mark, Davila, Maria G, Moore, Thomas J
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Case-Control Studies; Compartment Syndromes - diagnosis; Diseases of the osteoarticular system; Female; Humans; Injuries of the limb. Injuries of the spine; Injury Severity Score; Leg - blood supply; Leg Injuries - diagnosis; Leg Injuries - surgery; Magnetic Resonance Imaging; Male; Medical sciences; Microcirculation - physiology; Middle Aged; Orthopedic surgery; Oxygen Consumption - physiology; Probability; Reference Values; Regional Blood Flow; Sensitivity and Specificity; Spectroscopy, Near-Infrared; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Traumas. Diseases due to physical agents; Young Adult
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.H.00347

BackgroundNear-infrared spectroscopy measures the percentage of hemoglobin oxygen saturation in the microcirculation of tissue up to 3 cm below the skin. The purpose of this study was to describe the measurable response of normal tissue oxygenation in the leg after acute trauma with use of this technique.MethodsTwenty-six patients with acute unilateral tibial fractures and twenty-five uninjured volunteer control subjects were enrolled. Near-infrared spectroscopy measurements were obtained for both legs in all four compartmentsanterior, lateral, deep posterior, and superficial posterior. The twenty-six injured legs were compared with twenty-five uninjured legs (randomly selected) of the volunteer control group, with the contralateral limb in each patient serving as an internal control.ResultsThe mean tissue oxygenation for each compartment in the injured legs was 69% (anterior), 70% (lateral), 74% (deep posterior), and 70% (superficial posterior). In the control (uninjured) legs, the average tissue oxygenation percentage in each compartment was 54%, 55%, 60%, and 57%, respectively. Repeated-measures analysis revealed that near-infrared spectroscopy values averaged 15.4 percentage points (95% confidence interval, 12.2 to 18.6 percentage points) higher for injured legs than for uninjured legs, controlling for the value of the contralateral limb (p < 0.0001).ConclusionsTibial fracture produces a predictable increase in tissue oxygenation as measured by near-infrared spectroscopy. The corresponding compartment of the contralateral leg can provide strong utility as an internal control value when evaluating the hyperemic response to injury.Level of EvidencePrognostic Level I. See Instructions to Authors for a complete description of levels of evidence.