Near-Infrared Spectroscopy Allows for Monitoring of Bone Fracture Healing Via Changes in Oxygenation

Overview

Journal J Funct Biomater

Specialty Biomedical Engineering

Date 2024 Dec 27

PMID 39728184

Authors

Cedric Nowicki

Bergita Ganse

Affiliations

Soon will be listed here.

Abstract

Bone fractures are associated with hypoxia, but no longitudinal studies of perfusion measurements in human patients have been reported despite the clinical and research potential. In this longitudinal observational cohort study, the near-infrared spectroscopy (NIRS) device PortaMon was used to assess oxy-(OHb), deoxy-(HHb) and total (tHb) haemoglobin, as well as the differences between OHb and HHb (Hb) and the tissue saturation index (TSI) at three different depths in the fracture gap. Linear mixed effect models were fitted to analyse time effects. One-way ANOVAs were conducted to compare groups. The time points corresponding to minima were calculated via linear regression. In this study, 11 patients with tibial shaft fractures underwent longitudinal measurements. Additionally, 9 patients with diagnosed tibial shaft nonunion and 23 age-matched controls were measured once. In the longitudinal group, all fractures healed, and decreases in OHb and Hb (all < 0.05) were observed, with minima occurring 19-21 days after fracture. OHb values in nonunion patients did not differ from the minima in longitudinally measured union patients, whereas differences in HHb and tHb were significant (all < 0.05). Previously, the onset of hypoxia has been assumed to be much faster. The characteristic trajectories of the NIRS parameters OHb and Hb can be used to fulfil the need for a non-invasive method to monitor fracture healing. These results suggest that NIRS could supplement radiographs and clinical impressions in daily clinical practice and may enable earlier diagnosis of nonunion.

References

Siamwala J, Lee P, Macias B, Hargens A . Lower-body negative pressure restores leg bone microvascular flow to supine levels during head-down tilt. J Appl Physiol (1985). 2015; 119(2):101-9. DOI: 10.1152/japplphysiol.00028.2015. View

Ozkan S, Nolte P, van den Bekerom M, Bloemers F . Diagnosis and management of long-bone nonunions: a nationwide survey. Eur J Trauma Emerg Surg. 2018; 45(1):3-11. PMC: 6394533. DOI: 10.1007/s00068-018-0905-z. View

Ganse B, Bohle F, Pastor T, Gueorguiev B, Altgassen S, Gradl G . Microcirculation After Trochanteric Femur Fractures: A Prospective Cohort Study Using Non-invasive Laser-Doppler Spectrophotometry. Front Physiol. 2019; 10:236. PMC: 6442516. DOI: 10.3389/fphys.2019.00236. View

Ganse B . Methods to accelerate fracture healing - a narrative review from a clinical perspective. Front Immunol. 2024; 15:1384783. PMC: 11190092. DOI: 10.3389/fimmu.2024.1384783. View

Perrey S, Quaresima V, Ferrari M . Muscle Oximetry in Sports Science: An Updated Systematic Review. Sports Med. 2024; 54(4):975-996. PMC: 11052892. DOI: 10.1007/s40279-023-01987-x. View

Stegen S, Carmeliet G . The skeletal vascular system - Breathing life into bone tissue. Bone. 2017; 115:50-58. DOI: 10.1016/j.bone.2017.08.022. View

Menger M, Laschke M, Nussler A, Menger M, Histing T . The vascularization paradox of non-union formation. Angiogenesis. 2022; 25(3):279-290. PMC: 9249698. DOI: 10.1007/s10456-022-09832-x. View

Keeley T, Mann G . Defining Physiological Normoxia for Improved Translation of Cell Physiology to Animal Models and Humans. Physiol Rev. 2018; 99(1):161-234. DOI: 10.1152/physrev.00041.2017. View

Spencer J, Ferraro F, Roussakis E, Klein A, Wu J, Runnels J . Direct measurement of local oxygen concentration in the bone marrow of live animals. Nature. 2014; 508(7495):269-73. PMC: 3984353. DOI: 10.1038/nature13034. View

10.

Gomez-Barrena E, Ehrnthaller C . Long bone uninfected non-union: grafting techniques. EFORT Open Rev. 2024; 9(5):329-338. PMC: 11099576. DOI: 10.1530/EOR-24-0032. View

11.

Lu C, Rollins M, Hou H, Swartz H, Hopf H, Miclau T . Tibial fracture decreases oxygen levels at the site of injury. Iowa Orthop J. 2009; 28:14-21. PMC: 2603344. View

12.

Kiaer T . Bone perfusion and oxygenation. Animal experiments and clinical observations. Acta Orthop Scand Suppl. 1994; 257:1-41. View

13.

Siamwala J, Macias B, Lee P, Hargens A . Gender differences in tibial microvascular flow responses to head down tilt and lower body negative pressure. Physiol Rep. 2017; 5(4). PMC: 5328775. DOI: 10.14814/phy2.13143. View

14.

Grundnes O, Reikeras O . Blood flow and mechanical properties of healing bone. Femoral osteotomies studied in rats. Acta Orthop Scand. 1992; 63(5):487-91. DOI: 10.3109/17453679209154720. View

15.

Harrison A, Alt V . Low-intensity pulsed ultrasound (LIPUS) for stimulation of bone healing - A narrative review. Injury. 2021; 52 Suppl 2:S91-S96. DOI: 10.1016/j.injury.2021.05.002. View

16.

Ganse B, Orth M, Roland M, Diebels S, Motzki P, Seelecke S . Concepts and clinical aspects of active implants for the treatment of bone fractures. Acta Biomater. 2022; 146:1-9. DOI: 10.1016/j.actbio.2022.05.001. View

17.

McInnis J, Robb R, Kelly P . The relationship of bone blood flow, bone tracer deposition, and endosteal new bone formation. J Lab Clin Med. 1980; 96(3):511-22. View

18.

van Brakel F, Zhao Y, van der Eerden B . Fueling recovery: The importance of energy coupling between angiogenesis and osteogenesis during fracture healing. Bone Rep. 2024; 21:101757. PMC: 10990718. DOI: 10.1016/j.bonr.2024.101757. View

19.

Epari D, Lienau J, Schell H, Witt F, Duda G . Pressure, oxygen tension and temperature in the periosteal callus during bone healing--an in vivo study in sheep. Bone. 2008; 43(4):734-9. DOI: 10.1016/j.bone.2008.06.007. View

20.

Zura R, Xiong Z, Einhorn T, Watson J, Ostrum R, Prayson M . Epidemiology of Fracture Nonunion in 18 Human Bones. JAMA Surg. 2016; 151(11):e162775. DOI: 10.1001/jamasurg.2016.2775. View