title: Tourniquets may increase postoperative swelling and pain after internal fixation of ankle fractures.
abstract: Tourniquets frequently are used in orthopaedic surgery to provide a bloodless field. There is still controversy among authors regarding the benefits and potential risks of using a tourniquet. The objective of this prospective randomized study was to quantify the effect of tourniquet use on postoperative swelling, pain, and range of motion after open reduction and internal fixation of ankle fractures. Fifty-four patients with closed ankle fractures were treated surgically; 26 patients were operated on using a thigh tourniquet (Group A), and 28 patients had surgery without the use of a tourniquet (Group B). The groups of patients were similar for age, gender, fracture types, and operative procedures. There was no difference in operation time. Using a tourniquet during open reduction and internal fixation of ankle fractures did increase postoperative swelling and postoperative pain at Day 5 and at Week 6 after surgery. We found a trend for a better range of motion in the ankle until the 6-week followup in the nontourniquet group compared with the group in which the tourniquet was inflated. According to these results we do not recommend using a tourniquet for osteosynthesis of ankle fractures.
  
  
  METHODS
  Therapeutic study, Level I-1 (randomized controlled trial). See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Universitätsklinikum Freiburg, Klinik für Traumatologie, Hugstetter Strasse 55, 79106 Freiburg, Germany. ggkonrad@aol.com
authors.forename: Gerhard
authors.initials: G
authors.lastname: Konrad
authors.forename: Max
authors.initials: M
authors.lastname: Markmiller
authors.forename: Andreas
authors.initials: A
authors.lastname: Lenich
authors.forename: Edgar
authors.initials: E
authors.lastname: Mayr
authors.forename: Axel
authors.initials: A
authors.lastname: Rüter
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D016512:Ankle Injuries / Q000175:diagnosis / Q000601:surgery*; D004487:Edema / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D048228:Intermittent Pneumatic Compression Devices; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D017678:Sex Distribution; D014111:Tourniquets / Q000009:adverse effects*