Laser-assisted Indocyanine Green Angiography (LA-ICGA) is a novel method for objectively quantifying soft tissue perfusion. The primary aim of this study was to determine whether skin perfusion surrounding tibial plateau and pilon fractures is associated with the Tscherne classification for severity of soft tissue injury. The secondary aim was to determine if soft tissue perfusion improves from the time of injury to the time of definitive fracture fixation in fractures treated using a staged protocol.
Prospective cohort study
Academic trauma centre
Eight pilon fracture patients and 19 tibial plateau fracture patients that underwent open reduction internal fixation
Main Outcome Measurements:
Skin perfusion (fluorescence units) as measured by LA-ICGA
Six patients were classified as Tscherne grade 0, nine as grade 1, ten as grade 2, and two as grade 3. Perfusion decreased by 14 fu (95% CI: -21, -6, p<0.01) with each increase in Tscherne grade.
Sixteen patients underwent staged fixation with an external fixator (mean time to definitive fixation 14.1 days). The mean perfusion increased significantly at the time of definitive fixation by a mean of 13.9 fu (95% CI 4.8, 22.9; p=0.01)
LA-ICGA perfusion measures are associated with severity of soft tissue injury surrounding orthopaedic trauma fractures and appear to improve over time when fractures are stabilized in an external fixator. Further research is warranted to investigate whether objective perfusion measures are predictive of postoperative wound healing complications and whether this tool can be used to effectively guide timing of safe surgical fixation
Level of Evidence:
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.