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

Bergita Ganse; Franziska Böhle; Tatjana Pastor; Boyko Gueorguiev; Simon Altgassen; Gertraud Gradl; Bong-Sung Kim; Ali Modabber; Sven Nebelung; Frank Hildebrand; Matthias Knobe

doi:10.3389/fphys.2019.00236

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

Front Physiol. 2019 Mar 25:10:236. doi: 10.3389/fphys.2019.00236. eCollection 2019.

Authors

Affiliations

¹ Department of Orthopaedic Trauma Surgery, RWTH Aachen University Hospital, Aachen, Germany.
² Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zurich, Switzerland.
³ AO Research Institute Davos, Davos, Switzerland.
⁴ LVR Hospital Essen, University Duisburg-Essen, Essen, Germany.
⁵ Department of Plastic and Reconstructive Surgery, Hand Surgery - Burn Center, RWTH Aachen University Hospital, Aachen, Germany.
⁶ Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany.
⁷ Department of Radiology, RWTH Aachen University Hospital, Aachen, Germany.

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 (SO₂), 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 SO₂, Hb and flow. Each parameter showed comparable values for both legs prior to surgery. Significantly higher values in SO₂ and flow were registered in women compared to men before and after surgery. Smoking caused significant increases in SO₂, 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 SO₂ 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.

Keywords: SO2; age; diabetes; fracture; microcirculation; nicotine; smoking; trauma.