# Real-time fluorescence-based measurement of bone perfusion in post-traumatic infection

> **NIH NIH R01** · DARTMOUTH-HITCHCOCK CLINIC · 2021 · $448,954

## Abstract

Infection following bony fracture is one of the most prevalent and challenging complications in trauma patients
with an estimated annual cost of $35 billion in the US. (https://stacks.cdc.gov/view/cdc/11550)
Recurrent infection rates are unacceptably high at 30%, resulting in prolonged morbidity, loss of function,
and/or loss of limb. Vascular perfusion plays a critical role in the health of bone by delivering necessary
oxygen, nutrients, antibiotics, and endogenous immune cells. The management of bony infection is therefore
based on aggressive, thorough debridement in an effort to remove all poorly perfused bone through visual and
tactile clues such as color, turgor and extent of soft tissue stripping. However, there are no objectively
measurable or quantifiable methods to assess the bone perfusion and the success of removing devitalized
bone is based almost entirely on surgeon’s experience. Thus, the overall goal of this proposal is to develop
and evaluate an indocyanine green (ICG)-based dynamic contrast-enhanced fluorescence imaging (DCE-FI)
to objectively assess bone perfusion and guide surgical debridement. The scientific premise of this proposal
is underpinned by data from our prior pre-clinical work in a porcine model and our pilot clinical study
applying ICG-based DCE-FI to assess bone perfusion in patients during orthopaedic surgery. In these
studies, we established that DCE-FI can quantitatively assess bone perfusion in a measurable, reproducible
and predictable manner, and we developed analytic models differentiating the endosteal from periosteal
contribution to total blood supply. This model was then able to effectively differentiate healthy from damaged
bone with a linear decision boundary with 89% accuracy, in the pre-clinical porcine study. To attain our overall
objective, three aims will be pursued. In Aim 1 we will assess the relationship between post-debridement bone
perfusion, as measured using ICG-based DCE-FI, and recurrent infection/treatment failure. Additionally, we
will refine analytic models that assess the relative contribution of endosteal versus periosteal blood
supplies. In Aim 2 we will explore the relationship between dynamic contrast-enhanced MRI (DCE-MRI) and
DCE-FI to improve the three-dimensional analytic potential of DCE-FI. In Aim 3 we will develop streamlined
analytic tools into a user-centered interface that will optimize use of ICG-based DCE-FI derived data in
normal surgical workflow. Application of ICG-based DCE-FI has enormous potential to revolutionize
treatment of post-traumatic infections by minimizing treatment failure and minimizing bone resection
and ultimately revolutionize the standard of care for millions of trauma patients. This project leverages an
extensive infrastructure and experience in fluorescence-guided surgery as well as longstanding collaborations
between surgical subspecialties and biomedical engineers at Dartmouth and R Adams Cowley Shock Trauma
Center.

## Key facts

- **NIH application ID:** 10132991
- **Project number:** 5R01AR077157-02
- **Recipient organization:** DARTMOUTH-HITCHCOCK CLINIC
- **Principal Investigator:** Ida L Gitajn
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $448,954
- **Award type:** 5
- **Project period:** 2020-04-01 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10132991

## Citation

> US National Institutes of Health, RePORTER application 10132991, Real-time fluorescence-based measurement of bone perfusion in post-traumatic infection (5R01AR077157-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10132991. Licensed CC0.

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