Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May 19;103(10):860-868.
doi: 10.2106/JBJS.20.01458.

Effect of Tourniquet Use During Surgical Treatment of Open Fractures

Ida Leah Gitajn  1 , Paul M Werth  1 , Sheila Sprague  2 , Sofia Bzovsky  2 , Brad A Petrisor  2 , Kyle J Jeray  3 , Nathan N O'Hara  4 , Mohit Bhandari  2 , Gerard Slobogean  4 ; FLOW Investigators
Affiliations

Effect of Tourniquet Use During Surgical Treatment of Open Fractures

Ida Leah Gitajn et al. J Bone Joint Surg Am. .

Erratum in

Abstract

Background: We sought to evaluate whether tourniquet use, with the resultant ischemia and reperfusion, during surgical treatment of an open lower-extremity fracture was associated with an increased risk of complications.

Methods: This is a retrospective cohort study of 1,351 patients who had an open lower-extremity fracture at or distal to the proximal aspect of the tibia and who participated in the FLOW (Fluid Lavage of Open Wounds) trial. The independent variable was intraoperative tourniquet use, and the primary outcome measures were adjudicated unplanned reoperation within 1 year of the injury and adjudicated nonoperative wound complications.

Results: Unplanned reoperation and nonoperative wound complications were roughly even between the no-tourniquet (18.7% and 19.1%, respectively) and tourniquet groups (17.8% and 20.8%) (p = 0.78 and p = 0.52). Following matching, as determined by model interactions, tourniquet use was a significant predictor of unplanned reoperation in Gustilo Type-IIIA (odds ratio, 3.60; 95% confidence interval, 1.16 to 11.78) and IIIB fractures (odds ratio, 16.61; 95% confidence interval, 2.15 to 355.40).

Conclusions: The present study showed that tourniquet use did not influence the likelihood of complications following surgical treatment of an open lower-extremity fracture. However, in cases of severe open fractures, tourniquet use was associated with increased odds of unplanned reoperation; surgeons should be cautious with regard to tourniquet use in this setting.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The FLOW (Fluid Lavage of Open Wounds) trial was supported by research grants from the Canadian Institutes of Health Research (# MCT-93173), United States Army Institute of Surgical Research, Orthopaedic Trauma Research Program and Peer Reviewed Orthopaedic Research Program, and Association Internationale pour l’Ostéosynthèse Dynamique. The Stryker Corporation provided Surgilav irrigators for the trial for clinical sites in Asia. Zimmer, Inc., provided the Pulsavac irrigator at discounted rates to selected clinical sites in North America. Triad Medical donated the initial supply of castile soap. This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Orthopaedic Trauma Research Program under Award No. W81XWH-08-1-0473 and the Peer Reviewed Orthopaedic Research Program under Award No. W81XWH-12-1-0530. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (http://links.lww.com/JBJS/G390).

Comment in

References

    1. Sato J, Ishii Y, Noguchi H, Takeda M. Safety and efficacy of a new tourniquet system. BMC Surg. 2012 Aug 15;12:17.
    1. Sim J, Grocott N, Majeed H, McClelland D. Effect on hospital length of stay of tourniquet use during internal fixation of ankle fractures: randomized controlled trial. J Foot Ankle Surg. 2019 Jan;58(1):114-8.
    1. Kam PC, Kavanagh R, Yoong FF. The arterial tourniquet: pathophysiological consequences and anaesthetic implications. Anaesthesia. 2001 Jun;56(6):534-45.
    1. Smith TO, Hing CB. The efficacy of the tourniquet in foot and ankle surgery? A systematic review and meta-analysis. Foot Ankle Surg. 2010 Mar;16(1):3-8. Epub 2009 May 27.
    1. Smith TO, Hing CB. Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review. Knee. 2010 Mar;17(2):141-7. Epub 2009 Jul 19.