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Near-Infrared Spectroscopy in Lower Extremity Trauma
Michael S. Shuler, MD1; William M. Reisman, MD2; Thomas E. WhitesidesJr., MD3; Tracy L. Kinsey, MSPH1; E. Mark Hammerberg, MD4; Maria G. Davila, MD5; Thomas J. Moore, MD5
1 Athens Orthopedic Clinic, 1765 Old West Broad Street, Suite 200, Athens, GA 30606. E-mail address for M.S. Shuler: msimmss@hotmail.com
2 59 Executive Park South, Second Floor, Atlanta, GA 30329
3 958 Calvert Lane N.E., Atlanta, GA 30319
4 120 Montreal Street, Playa Del Rey, CA 90293
5 49 Jesse Hill Jr. Drive, Suites 313 (M.G.D.) and 307 (T.J.M.), Atlanta, GA 30303
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from Somanetics. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Grady Memorial Hospital and Emory University, Atlanta, Georgia

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Jun 01;91(6):1360-1368. doi: 10.2106/JBJS.H.00347
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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.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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