Assessment of soft tissue injury in open tibial shaft fractures by transcutaneous oximetry

Transcutaneous oximetry was performed on 32 patients with 33 open tibial shaft fractures in an attempt to identify those patients at risk for the subsequent development of serious complications. Oxygen electrodes were placed on areas of intact skin, over viable compartments at the fracture site (wound) as well as on the anterior chest wall (control). Simultaneous wound and chest wall measurements were obtained after equilibration (30 minutes) on both room air and 100% oxygen. Values obtained were expressed as absolute values and as percentages of the wound measurement divided by the chest measurement. The study group consisted of 27 male and five female patients with an average age of 37 years (range, 17-63 years). There were 8 Grade I, 12 Grade II, and 13 Grade III fractures as described by Gustilo et al. Complications requiring medical or surgical intervention occurred in six patients: four deep infections, one deep vein thrombosis, and one superficial infection with severe bone and soft tissue loss requiring multiple procedures. Transcutaneous oximetry with patients breathing 100% oxygen was found to correlate with the development of complications in this study group. Five (42%) of 12 patients with transcutaneous oximetry values ≤ 85 mm Hg and a wound-to-chest ratio ≤ 25% developed a complication, whereas only one of 19 patients with either a fracture site-value greater than 85 mm Hg or a wound to chest ratio greater than 25% developed a complication (p = 0.007).