Initial Experience with Infrared Thermography for Assessing Bone Tissue Viability in Gunshot Fractures of the Extremities Involving Articular and Periarticular Regions

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Summary. Background. Infrared thermography (IRT) is widely used in vascular medicine, orthopedics, traumatology, the diagnosis of inflammatory conditions, and the assessment of inflammatory process development [12]. To date, scientific literature contains no studies specifically addressing the assessment of bone tissue viability in combat trauma using IRT. Existing studies have primarily focused on evaluating perfusion and delineating areas of soft-tissue necrosis, as well as the early detection of infectious inflammation [2, 7, 9, 12]. Objective. To evaluate the diagnostic capability of IRT as a method for intraoperative assessment of bone tissue viability in periarticular gunshot fractures associated with bone and soft-tissue defects. Materials and Methods. The study included 10 clinical cases of comminuted periarticular gunshot fractures with primary bone and soft-tissue defects. Thermographic examinations were performed using a portable FLIR C5 camera (FLIR Systems, USA). Bone fragment viability was assessed based on central temperature, temperature gradient (ΔT), the bleeding test, and the presence of cold zones. Results. The study demonstrated that, in 72% of cases, IRT enabled differentiation of viable bone areas from avascular fragments, allowing preservation of bone structures and primary reconstruction. In 28% of cases, occult areas of necrosis (ΔT > 4.0°C) were identified, providing an indication for limited or radical resection of nonviable fragments and helping to prevent the subsequent development of chronic osteomyelitis. Conclusions. IRT proved effective for assessing changes in bone fragment viability over time. This initial experience with IRT for assessing bone tissue viability in periarticular gunshot fractures demonstrates improved intraoperative planning of the extent of surgical intervention and indicates a consistent trend toward optimizing treatment outcomes in patients with complex combat-related joint injuries.

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