Sepehri A, Slobogean GP, O'Hara NN, McKegg P, Rudnicki J, Atchison J, O'Toole RV, Sciadini MF, LeBrun CT, Nascone JW, Johnson AJ, Gitajn IL, Elliott JT, Scolaro JA, Pensy RA. Assessing Soft Tissue Perfusion Using Laser-Assisted Angiography in Tibial Plateau and Pilon Fractures: A Pilot Study.
J Orthop Trauma 2021;
35:626-631. [PMID:
34797781 PMCID:
PMC8918020 DOI:
10.1097/bot.0000000000002100]
[Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES
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.
DESIGN
Prospective cohort study.
SETTING
Academic trauma center.
PATIENTS
Eight pilon fracture patients and 19 tibial plateau fracture patients who underwent open reduction internal fixation.
MAIN OUTCOME MEASURES
Skin perfusion (fluorescence units) as measured by LA-ICGA.
RESULTS
Six patients were classified as Tscherne grade 0, 9 as grade 1, 10 as grade 2, and 2 as grade 3. Perfusion decreased by 14 fluorescence units (95% confidence interval, -21 to -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 fluorescence units (95% confidence interval 4.8-22.9; P = 0.01).
CONCLUSIONS
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.
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