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

Abstract

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. 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\u2009=\u200962) were compared with patients in the non-tourniquet group (n\u2009=\u200969). 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\u2009<\u20090.05). The mean operative time was 64.7\u2009±\u20093.5 min in the tourniquet group and 76.0\u2009±\u20096.1 min in the non-tourniquet group (P\u2009<\u20090.05). The estimated intraoperative and postoperative blood loss was 56.6\u2009±\u200933.3 and 100.0\u2009±\u200925.3 mL, respectively, in the tourniquet group and 205.0\u2009±\u200931.6 and 38.3\u2009±\u200919.8 mL, respectively, in the non-tourniquet group (P\u2009<\u20090.05). The VAS pain scores 24 h, 48 h, and 72 h postoperatively were 4.3\u2009±\u20091.8, 3.1\u2009±\u20091.2, and 2.0\u2009±\u20090.5 points, respectively, in the tourniquet group and 2.1\u2009±\u20091.1, 1.6\u2009±\u20091.0, and 1.0\u2009±\u20090.3 points, respectively, in the non-tourniquet group (P\u2009<\u20090.05). 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.