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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: msimmss@hotmail.com

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