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Effect of tourniquet application on postoperative outcomes in sinus tarsi approach for intra-articular calcaneus fractures

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Tourniquets are commonly used during foot and ankle surgery to provide a bloodless operative field and increase surgical comfort, despite the potential risks associated with it. This study compared postoperative outcomes of tourniquet-assisted and non-tourniquet-assisted operative fixation of calcaneal fractures via the sinus tarsi approach.

Materials and methods

A retrospective study from March 2015 to December 2018 revealed 131 patients with closed calcaneal fractures who underwent minimally invasive surgery at our hospital. Visualization, operating time, blood loss, and postoperative pain were collected. Patients in the tourniquet group (n = 62) were compared with patients in the non-tourniquet group (n = 69).

Results

The visibility of the surgical field was fair/poor in 2 cases in the tourniquet group and fair/poor in 19 cases in the non-tourniquet group (P < 0.05). The mean operative time was 64.7 ± 3.5 min in the tourniquet group and 76.0 ± 6.1 min in the non-tourniquet group (P < 0.05). The estimated intraoperative and postoperative blood loss was 56.6 ± 33.3 and 100.0 ± 25.3 mL, respectively, in the tourniquet group and 205.0 ± 31.6 and 38.3 ± 19.8 mL, respectively, in the non-tourniquet group (P < 0.05). The VAS pain scores 24 h, 48 h, and 72 h postoperatively were 4.3 ± 1.8, 3.1 ± 1.2, and 2.0 ± 0.5 points, respectively, in the tourniquet group and 2.1 ± 1.1, 1.6 ± 1.0, and 1.0 ± 0.3 points, respectively, in the non-tourniquet group (P < 0.05).

Conclusion

Tourniquet application during the sinus tarsi approach for calcaneal fractures can significantly improve surgical visualization and reduce intraoperative blood loss. However, adverse events associated with the use of tourniquets include increased postoperative pain and bleeding. Due to increased postoperative bleeding and pain, more attention should be given to the postoperative phase in patients treated with tourniquets.

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Availability of data and materials

The data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Zaidi R, Hasan K, Sharma A et al (2014) Ankle arthroscopy: a study of tourniquet versus no tourniquet. Foot Ankle Int 35(5):478–482

    Article  Google Scholar 

  2. Dimnjaković D, Hrabač P, Bojanić I (2017) Value of tourniquet use in anterior ankle arthroscopy: a randomized controlled trial. Foot Ankle Int 38(7):716–722

    Article  Google Scholar 

  3. Konrad G, Markmiller M, Lenich A et al (2005) Tourniquets may increase postoperative swelling and pain after internal fixation of ankle fractures. Clin Orthop 433:189–194

    Article  Google Scholar 

  4. Irving G, Noakes T (1989) The protective role of local hypothermia in tourniquet-induced ischaemia of muscle. J Bone Jt Sur 67(2):297–301

    Google Scholar 

  5. Smith T, Hing C (2010) The efficacy of the tourniquet in foot and ankle surgery? A systematic review and meta-analysis. Foot Ankle Surg 16(1):3–8

    Article  CAS  Google Scholar 

  6. Backes M, Schepers T, Beerekamp MSH et al (2014) Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach. Int Orthop 38(4):767–773

    Article  Google Scholar 

  7. Bernasconi A, Iorio P et al (2021) Use of intramedullary locking nail for displaced intraarticular fractures of the calcaneus: what is the evidence? Arch Orthop Trauma Surg 11:1–2

    Google Scholar 

  8. Richter I, Krähenbühl N et al (2021) Mid-to long-term outcome in patients treated with a mini-open sinus-tarsi approach for calcaneal fractures. Arch Orthop Trauma Surg 141(4):611–617

    Article  Google Scholar 

  9. Park J, Che JH (2017) The sinus tarsi approach in displaced intra-articular calcaneal fractures. Arch Orthop Trauma Surg 137(8):1055–1065

    Article  Google Scholar 

  10. Sanders R, Fortin P, DiPasquale T et al (1993) Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res 290:87–95

    Google Scholar 

  11. Sukprasert M, Choktanasiri W, Ayudhya N et al (2006) Increase accuracy of visual estimation of blood loss from education programme. J Med Assoc Thai 89(Suppl 4):S54-59

    PubMed  Google Scholar 

  12. Mora S, Zalavras CG, Wang L et al (2002) The role of pulsatile cold compression in edema resolution following ankle fractures: a randomized clinical trial. Foot Ankle Int 23(11):999–1002

    Article  Google Scholar 

  13. Hutchinson DT, Wang AA (2010) Releasing the tourniquet in carpal tunnel surgery. Hand 5(1):57–59

    Article  Google Scholar 

  14. Sapega AA, Heppenstall RB, Chance B et al (1985) Optimizing tourniquet application and release times in extremity surgery. A biochemical and ultrastructural study. J Bone Jt Surg 67(2):303–314

    Article  CAS  Google Scholar 

  15. Liu D, Graham D, Gillies K et al (2014) Effects of tourniquet use on quadriceps function and pain in total knee arthroplasty. Knee Surg Relat Res 26(4):207

    Article  Google Scholar 

  16. Brancaccio P, Maffulli N, Limongelli FM (2007) Creatine kinase monitoring in sport medicine. Br Med Bull 81(1):209–230

    Article  Google Scholar 

  17. Ding L, He Z, Xiao H et al (2013) Risk factors for postoperative wound complications of calcaneal fractures following plate fixation. Foot Ankle Int 34(9):1238–1244

    Article  Google Scholar 

  18. Stavem K, Naumann M, Sigurdsen U et al (2017) The association of body mass index with complications and functional outcomes after surgery for closed ankle fractures. Bone Jt J 99(10):1389–1398

    Article  Google Scholar 

  19. Wu K, Wang C, Wang Q et al (2014) Regression analysis of controllable factors of surgical incision complications in closed calcaneal fractures. J Res Med Sci 19(6):495

    PubMed  PubMed Central  Google Scholar 

  20. Benedick A, Rivera T, Vallier HA (2020) Effect of tourniquet use during ankle fracture fixation on wound healing and infectious complications. Foot Ankle Int 41:714–720

    Article  Google Scholar 

  21. Spagnolo R, Bonalumi M, Pace F, Capitani D (2010) Calcaneus fractures, results of the sinus tarsi approach: 4 years of experience. Eur J Orthop Surg Traumatol 20(1):37

    Article  Google Scholar 

  22. Kikuchi C, Charlton TP, Thordarson DB (2013) Limited sinus tarsi approach for intra-articular calcaneus fractures. Foot Ankle Int 34(12):1689–1694

    Article  Google Scholar 

  23. Maffulli N, Testa V, Capasso G (1993) Use of a tourniquet in the internal fixation of fractures of the distal part of the fibula. A prospective, randomized trial. J Bone Jt Surg 75(5):700–703

    Article  CAS  Google Scholar 

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Acknowledgements

The authors wish to thank all participants who volunteered to take part in this study.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Department of Orthopedics, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China

    Hamood H. G. Zaid, Wu Di, Tianyuan Zhao & Maowei Yang

  2. Department of Rehabilitation Medicine, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, China

    Rufei Yang

Authors
  1. Hamood H. G. Zaid
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  2. Wu Di
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  3. Rufei Yang
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  4. Tianyuan Zhao
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  5. Maowei Yang
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Contributions

MWY, conceived this study and primary surgeon. HHGZ, drafting the manuscript and data analysis, HHGZ and DW, made contributions to the study conception and design. RFY, and TYZ carried out data collection. All authors were involved in the preparation and revision of the manuscript and have approved the submitted version.

Corresponding author

Correspondence to Maowei Yang.

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Conflict of interest

All authors declare that there are no personal or commercial relationships related to this work that would lead to a conflict of interest.

Ethics committee approval

This study was approved by the hospital’s institutional review board (No. 2020-217-2).

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Written informed consent was obtained from patients who participated in this study.

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Zaid, H.H.G., Di, W., Yang, R. et al. Effect of tourniquet application on postoperative outcomes in sinus tarsi approach for intra-articular calcaneus fractures. Arch Orthop Trauma Surg 142, 2695–2700 (2022). https://doi.org/10.1007/s00402-021-04059-9

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  • DOI: https://doi.org/10.1007/s00402-021-04059-9

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