Impact of Tourniquet Use During Intramedullary Tibial Nailing on Clinical Outcomes

The objective of this retrospective study was to investigate the impact of tourniquet use during intramedullary tibial nailing on clinical outcomes at a regional Level I Trauma Center. One hundred ninety-four patients with intramedullary tibial fixation over a 5-year period at a single institution were studied following Institutional Review Board (IRB) approval. Patients were stratified into 81 polytrauma patients and 113 patients with isolated tibial shaft injuries. Patients were then stratified within these two groups according to whether or not a tourniquet was used intraoperatively (including during reaming). Postoperative narcotic use, length of stay, operating room (OR) time, tourniquet time, estimated blood loss, units of blood utilized, infection rate, and age were the outcome variables. No significant differences were found for any outcome measure (p ≥ 0.05), including age, narcotic use, OR time, postoperative inpatient days, estimated blood loss, and units of blood used between tourniquet and nontourniquet patients. Statistically significant differences were found between isolated and nonisolated fracture patients for postanesthesia care unit (PACU) morphine dose equivalents (MDEs), with isolated tibia fracture patients requiring more MDEs (13.80 vs. 9.92 units; p = 0.025). Nonisolated tibia patients had more inpatient days (14.88 vs. 3.16 days; p = 0.001), greater estimated blood loss (252.44 vs. 128.07 mL; p = 0.001), and more units of blood (5.07 vs. 2.29 units; p = 0.017). Thermal necrosis of the tibia was not seen in any patient within any group. Tourniquet use did not significantly affect clinical outcomes. This provides surgeons with updated data on the impact of tourniquet use on clinical outcomes given the modernization of techniques for tibial intramedullary nailing. There were statistically significant differences between isolated tibia fractures and polytrauma patients for postoperative length of stay, estimated blood loss, and units of blood; however, this was unrelated to tourniquet use and would be expected for polytraumatic patients who commonly have a longer postoperative recovery. (Journal of Surgical Orthopaedic Advances 33(3):181-183, 2024).