Assessment of the Use of Tourniquet in the Plating of Non-Union of the Tibia

Abstract

Background: In non-union surgery, tourniquet may be needed to prevent the increased bleeding during surgical dissection caused by fibrosis and provide clearer surgical field in the presence of altered anatomy due to deformity. Tourniquets have been shown to be associated with adverse effects when used in plating acute tibial fractures but the effects in plating non-union of the tibia have not been studied
Objective: This study was aimed at evaluating the appropriateness of using tourniquet in plating non-union of the tibia.
Design: An interventional study.
Setting: National Orthopaedic Hospital, Dala, Kano, Nigeria.
Subjects: Two groups of patients who had plating of nonunion of the tibia with (Study Group) and without (Control Group) thigh tourniquet. There were 14 patients in each group.
Intervention: Application of pneumatic thigh tourniquet in the study group.
Main outcome measures: Post-operative pain, postoperative limb size and wound infection.
Results: Post-operative pain score (p=0.028) and postoperative limb size (p=0.0001) were significantly greater in Study Group patients at post-operative days 5 and 2 respectively. Study Group patients also stayed longer in hospital (p=0.0039) and had non-statistically significant (p=0.622) higher infection rate (42.9%) than Control Group patients (28.6%). Intraoperative blood loss was significantly greater (p=0.0001) in Control Group patients but no statistically significant difference (p=0.986) in postoperative blood loss was found.
Conclusion: Tourniquet should be used with caution in plating non-union of the tibia as it may be associated with increased morbidity.

Keywords: Tourniquet, plating, non-union, fracture, tibia