Maryam Khodabakhshi, Gholamhossein Mahmoudirad, Reza Bahador
Background: Tourniquet is used in limb surgeries in order to create a clear blood-free surgical filed. Despite its considerable benefits, tourniquet has potential risks such as neuromuscular injuries, decreased joint range of motion, and pain. Present study was made to compare the effects of two tourniquet times on pain and knee range of motion after internal plate fixation of tibia fractures.
Methods: This randomized controlled trial was performed on forty patients with acute closed extra-articular tibia fractures who were candidates for internal plate fixation. The patients were conveniently recruited and randomly allocated to groups A and B. In group A, tourniquet was deflated after tibial fixation and before wound closure while in group B, it was deflated after wound closure and compression dressing. The level of pain as well as knee range of motion were measured before, 24 hours after, and fourteen days after the surgery using a 30 cm goniometer and a 0-10 visual analogue scale, respectively.
Results: Pain intensity score in group A was significantly lower than group B both at 24 hours and fourteen days after the surgery. Knee range of motion in group A was also significantly greater than group B at 24 hours after the surgery. However, fourteen days after the surgery, there was no significant difference between the groups regarding knee range of motion.
Conclusion: Tourniquet deflation before wound closure is associated with lower levels of postoperative pain and greater postoperative knee range of motion among patients undergoing internal plate fixation of tibia fractures. Possible explanations for these findings are faster reperfusion, reduced duration of ischemia, and slighter ischemic and mechanical injuries to nerves, muscles, and the skin.