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Front. Physiol. | doi: 10.3389/fphys.2019.00236

Microcirculation after trochanteric femur fractures: a prospective cohort study using non-invasive laser-Doppler spectrophotometry

 Bergita Ganse1*,  Franziska Böhle1,  Tatjana Pastor2,  Boyko Gueorguiev3, Simon Altgassen1, Gertraud Gradl4,  Bong-Sung Kim1,  Ali Modabber1, Sven Nebelung1, Frank Hildebrand1 and  Matthias Knobe1
  • 1Department of Orthopaedic Trauma Surgery, Faculty of Medicine, RWTH Aachen University, Germany
  • 2Balgrist University Hospital, Switzerland
  • 3AO Research Institute, Switzerland
  • 4University of Duisburg-Essen, Germany

Proximal femur fractures represent a major healthcare problem in the ageing society. High rates of postoperative 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 2mm, 8mm and 15mm depths, before surgery and 8h, 24h, 48h, 4d, 7d and 12d 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 8mm 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: Microcirculation, Fracture, Trauma, SO2, Smoking, age, diabetes, Nicotine

Received: 29 Oct 2018; Accepted: 22 Feb 2019.

Edited by:

Joaquin Garcia-Estañ, University of Murcia, Spain

Reviewed by:

Catarina Rosado, Universidade Lusófona, Portugal
Tomasz Lekszycki, Warsaw University of Technology, Poland
Carl Neuerburg, Department of General, Accident and Reconstructive Surgery, Hospital of the University of Munich, Germany  

Copyright: © 2019 Ganse, Böhle, Pastor, Gueorguiev, Altgassen, Gradl, Kim, Modabber, Nebelung, Hildebrand and Knobe. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Bergita Ganse, Faculty of Medicine, RWTH Aachen University, Department of Orthopaedic Trauma Surgery, Aachen, Germany,