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Near-Infrared Spectroscopy in Lower Extremity Trauma

Shuler, Michael S. MD; Reisman, William M. MD; Whitesides, Thomas E. Jr. MD; Kinsey, Tracy L. MSPH; Hammerberg, E. Mark MD; Davila, Maria G. MD; Moore, Thomas J. MD

Journal of Bone & Joint Surgery - American Volume: 01 June 2009 - Volume 91 - Issue 6 - p 1360–1368
doi: 10.2106/JBJS.H.00347
Scientific Articles

Background: Near-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.

Methods: Twenty-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 compartments: anterior, 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.

Results: The 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).

Conclusions: Tibial 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 Evidence: Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence.

1Athens Orthopedic Clinic, 1765 Old West Broad Street, Suite 200, Athens, GA 30606. E-mail address for M.S. Shuler:

259 Executive Park South, Second Floor, Atlanta, GA 30329

3958 Calvert Lane N.E., Atlanta, GA 30319

4120 Montreal Street, Playa Del Rey, CA 90293

549 Jesse Hill Jr. Drive, Suites 313 (M.G.D.) and 307 (T.J.M.), Atlanta, GA 30303

Copyright 2009 by The Journal of Bone and Joint Surgery, Incorporated
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