Muhamed M Farhan-Alanie1, Fatema Dhaif2, Alex Trompeter3, Martin Underwood4, Joyce Yeung4, Nick Parsons5, Andy Metcalfe6, Peter D H Wall6. 1. Academic Clinical Fellow Specialty Trainee in Trauma and Orthopaedic Surgery, Warwick Medical School & University Hospital Coventry & Warwickshire, Coventry, UK. muhamed.farhan-alanie@nhs.net. 2. Academic Clinical Fellow Specialty Trainee in Trauma and Orthopaedic Surgery, Warwick Medical School & University Hospital Coventry & Warwickshire, Coventry, UK. 3. Consultant Orthopaedic Trauma Surgeon, Reader in Orthopaedic Surgery, St George's University Hospital NHS Foundation Trust, St George's University of London, London, UK. 4. Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, UK. 5. Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. 6. Consultant Orthopaedic Surgeon and Associate Clinical Professor in Trauma and Orthopaedic Surgery, Warwick Medical School & University Hospital Coventry & Warwickshire, Coventry, UK.
Abstract
PURPOSE: Tourniquet use in lower limb fracture surgery may reduce intra-operative bleeding, improve surgical field of view and reduce length of procedure. However, tourniquets may result in pain and the production of harmful metabolites cause complications or affect functional outcomes. This systematic review aimed to compare outcomes following lower limb fracture surgery performed with or without tourniquet. METHODS: We searched databases for RCTs comparing lower limb fracture surgery performed with versus without tourniquet reporting on outcomes pain, physical function, health-related quality of life, complications, cognitive function, blood loss, length of stay, length of procedure, swelling, time to union, surgical field of view, volume of anaesthetic agent, biochemical markers of inflammation and injury, and electrolyte and acid-base balance. Random-effects meta-analysis was performed. PROSPERO ID CRD42020209310. RESULTS: Six RCTs enabled inclusion of 552 procedures. Pooled analysis demonstrated that tourniquet use reduced length of procedure by 6 minutes (95% CI -10.12 to -1.87; p < 0.010). We were unable to exclude increased harms from tourniquet use. Pooled analysis showed post-operative pain score was higher in tourniquet group by 12.88 on 100-point scale (95% CI -1.25-27.02; p = 0.070). Risk differences for wound infection, deep venous thrombosis and re-operation were 0.06 (95% CI -0.00-0.12; p = 0.070), 0.05 (95% CI -0.02-0.11; p = 0.150) and 0.03 (95% CI -0.03-0.09; p = 0.340). CONCLUSION: Tourniquet use was associated with a reduced length of procedure. It is possible that tourniquets also increase incidence of important complications, but the data are too sparse to draw firm conclusions. Methodological weaknesses of the included RCTs prevent any solid conclusions being drawn for outcomes investigated. Further studies are required to address these limitations.
PURPOSE: Tourniquet use in lower limb fracture surgery may reduce intra-operative bleeding, improve surgical field of view and reduce length of procedure. However, tourniquets may result in pain and the production of harmful metabolites cause complications or affect functional outcomes. This systematic review aimed to compare outcomes following lower limb fracture surgery performed with or without tourniquet. METHODS: We searched databases for RCTs comparing lower limb fracture surgery performed with versus without tourniquet reporting on outcomes pain, physical function, health-related quality of life, complications, cognitive function, blood loss, length of stay, length of procedure, swelling, time to union, surgical field of view, volume of anaesthetic agent, biochemical markers of inflammation and injury, and electrolyte and acid-base balance. Random-effects meta-analysis was performed. PROSPERO ID CRD42020209310. RESULTS: Six RCTs enabled inclusion of 552 procedures. Pooled analysis demonstrated that tourniquet use reduced length of procedure by 6 minutes (95% CI -10.12 to -1.87; p < 0.010). We were unable to exclude increased harms from tourniquet use. Pooled analysis showed post-operative pain score was higher in tourniquet group by 12.88 on 100-point scale (95% CI -1.25-27.02; p = 0.070). Risk differences for wound infection, deep venous thrombosis and re-operation were 0.06 (95% CI -0.00-0.12; p = 0.070), 0.05 (95% CI -0.02-0.11; p = 0.150) and 0.03 (95% CI -0.03-0.09; p = 0.340). CONCLUSION: Tourniquet use was associated with a reduced length of procedure. It is possible that tourniquets also increase incidence of important complications, but the data are too sparse to draw firm conclusions. Methodological weaknesses of the included RCTs prevent any solid conclusions being drawn for outcomes investigated. Further studies are required to address these limitations.
Authors: Magdi M I Yassin; Denis W Harkin; Aires A B Barros D'Sa; M Isla Halliday; Brian J Rowlands Journal: World J Surg Date: 2001-10-25 Impact factor: 3.352
Authors: David Constantinescu; William Pavlis; Suleiman Sudah; Dennis Vanden Berge; Joseph Geller; Victor Hugo Hernandez Journal: J Orthop Date: 2022-09-10