Microcirculation After Trochanteric Femur Fractures: A Prospective Cohort Study Using Non-invasive Laser-Doppler Spectrophotometry

Abstract

Proximal femur fractures represent a major healthcare problem in the aging society. High rates of post-operative infections are linked to risk factors that seem to affect local microcirculation. Patterns and time courses of alterations in microcirculation have, however, not been previously investigated. The aim of this prospective cohort study was to evaluate perioperative changes in microcirculation after trochanteric femur fractures using non-invasive laser-Doppler spectrophotometry to analyze how oxygen saturation (SO 2 ), hemoglobin content (Hb) and blood flow changed before and after surgery, and how these parameters were altered by implant type, gender, smoking, diabetes and age. Measurements were separately recorded for nine locations around the greater trochanter in 2, 8, and 15 mm depths, before surgery and 8, 24, 48 h, 4, 7, and 12 days after surgery in 48 patients. Three implants were compared: Dynamic Hip Screw, Gamma3 Nail, and Percutaneous Compression Plate. Surgery resulted in significant differences between the healthy and injured leg in SO 2 , Hb and flow. Each parameter showed comparable values for both legs prior to surgery. Significantly higher values in SO 2 and flow were registered in women compared to men before and after surgery. Smoking caused significant increases in SO 2 , Hb, and flow only in the superficial layer of the skin after surgery. Diabetes decreased blood flow at 2 and 8 mm depth and increased SO 2 at 8 and 15 mm depth after surgery. Age revealed a significant negative correlation with flow. The ability to increase the flow rate after surgery decreased with age. Comparison of implants indicated the minimally invasive implant PCCP altered microcirculation less than the DHS or the Gamma3 nail. Overall, the proximal femur fracture alone did not alter local skin microcirculation significantly in a way comparable to the effect caused by surgery. In conclusion, microcirculation after proximal femur fractures is highly affected by surgery, gender, smoking, diabetes, age and implant in ways specified in this study.

Trochanteric Femur Fractures: Application of Skeletal Traction during Surgery Does Not Alter Soft-Tissue Microcirculation

“…The University Hospital IRB (reference number EK006/11, date of approval: 15 April 2011) approved the study protocol. This prospective cohort study was registered on www.ClinicalTrials.gov (number NCT01264172, date 21 July 2010) with the title "Identification of Microcirculation and Inflammation after Minimally-invasive Osteosynthesis of the Proximal Femur" (MicroProxFem) [13]. Written informed consent was collected in accordance with the Declaration of Helsinki.…”

“…Furthermore, microcirculation could potentially be impaired by the pull on the soft-tissue and compression of blood vessels, as well as by a release of vasoactive factors from the fracture site. Ganse et al [13] published the first study to measure and show changes in microcirculation after CRIF of trochanteric femur fractures and their relation to risk factors, and the type of implant. Significant differences in the parameters of microcirculation were found comparing the healthy and the injured leg, as well as throughout the course of the post-operative period [13].…”

“…Decreases in blood supply and venous outflow diminish oxygen supply and cause hypoxia, acidosis, collection of metabolites, and oxidative/nitroxidative stress and, subsequently, lead to Ganse et al [13] published the first study to measure and show changes in microcirculation after CRIF of trochanteric femur fractures and their relation to risk factors, and the type of implant. Significant differences in the parameters of microcirculation were found comparing the healthy and the injured leg, as well as throughout the course of the post-operative period [13]. Microcirculation plays an important role in keeping the local environment optimal for tissue healing.…”

“…Ganse et al [ 13 ] published the first study to measure and show changes in microcirculation after CRIF of trochanteric femur fractures and their relation to risk factors, and the type of implant. Significant differences in the parameters of microcirculation were found comparing the healthy and the injured leg, as well as throughout the course of the post-operative period [ 13 ].…”

“…Microcirculation plays an important role in keeping the local environment optimal for tissue healing. Decreases in blood supply and venous outflow diminish oxygen supply and cause hypoxia, acidosis, collection of metabolites, and oxidative/nitroxidative stress and, subsequently, lead to poor tissue healing, impairment of the immune system, and possibly even cell death and necrosis [ 13 , 14 , 15 ]. Impairment of the local immune system promotes bacterial growth and inflammation [ 14 ].…”