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Assessing Soft Tissue Perfusion Using Laser-Assisted Angiography in Tibial Plateau and Pilon Fractures: A Pilot

Aresh Sepehri¹, Gerard P Slobogean¹, Nathan N O'Hara¹

¹Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.

Journal of Orthopaedic Trauma

|November 19, 2021

Summary

Skin perfusion around tibial plateau and pilon fractures correlates with soft tissue injury severity. Perfusion improves with external fixator stabilization before definitive fixation, aiding surgical timing decisions.

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Area of Science:

Orthopaedic Trauma Surgery
Vascular Assessment in Fractures
Soft Tissue Injury Evaluation

Background:

Tibial plateau and pilon fractures involve significant soft tissue injury.
Accurate assessment of soft tissue viability is crucial for fracture management.
The Tscherne classification is used to grade soft tissue injury severity.

Purpose of the Study:

To investigate the association between skin perfusion and the Tscherne classification in tibial plateau and pilon fractures.
To determine if soft tissue perfusion changes from injury to definitive fracture fixation.
To evaluate the utility of laser angiography with indocyanine green (LA-ICGA) for perfusion assessment.

Main Methods:

Prospective cohort study conducted at an academic trauma center.
Inclusion of 27 patients (8 pilon, 19 tibial plateau fractures) undergoing open reduction internal fixation.
Skin perfusion measured using LA-ICGA, quantified in fluorescence units.

Main Results:

A significant inverse correlation was found between Tscherne grade and skin perfusion (P < 0.01).
Each increase in Tscherne grade corresponded to a decrease in perfusion.
Patients treated with staged fixation using external fixators showed improved perfusion (P = 0.01) by the time of definitive fixation.

Conclusions:

LA-ICGA derived perfusion measures are linked to the severity of soft tissue injury in orthopaedic trauma.
Perfusion appears to increase over time with external fixator stabilization.
Further research is needed to determine if LA-ICGA can predict wound healing and guide surgical timing.