Abstract
Purpose
Our objective was to determine the effect of a tourniquet on postoperative pain and
function following open reduction and internal fixation (ORIF) of the distal radius.
We hypothesized that patients treated with local lidocaine and epinephrine and no-tourniquet
would have improved postoperative pain and function when compared with patients treated
with standard tourniquet use.
Materials and Methods
This was a prospective, blinded randomized trial of 35 patients aged 18 to 85 who
sustained acute closed distal radius fractures treated with a volar plate. Randomization
placed 16 patients in the “tourniquet” group and 19 in the “no-tourniquet” group.
Lidocaine with epinephrine was used to lessen operative bleeding in the no-tourniquet
group. Each patient was assessed preoperatively and at 2 weeks, 6 weeks, and 3 months
postoperatively. Patient-reported outcomes included Numerical Rating Scale (NRS) pain
score, Patient-Reported Wrist and Hand Evaluation (PRWHE), Patient-Reported Outcome
Measurement Information System (PROMIS) pain interference and physical function scores,
and QuickDASH scores. Secondary outcomes included estimated blood loss and quality
of visualization as assessed by the operating surgeon.
Results
The no-tourniquet group demonstrated significantly improved PRWHE function scores
at 6 weeks when compared with the tourniquet group. The no-tourniquet group also demonstrated
significantly improved PRWHE pain scores from preoperatively to 2 weeks, whereas the
tourniquet group did not. There were no other significant differences in NRS pain
scores, PRWHE total scores, PROMIS pain interference, PROMIS physical function scores,
or QuickDash scores between the two groups. There was no difference in operative time
between the two groups. Estimated blood loss was similar between both the groups.
There was a difference in subjective visualization favoring tourniquet use, with one
patient in the no-tourniquet group crossing over to the tourniquet group because of
poor visualization.
Conclusion
ORIF of distal radius fractures without a tourniquet and with lidocaine/epinephrine
is safe and effective and may contribute to early improvements in function and pain
without prolonging operative time or increasing blood loss.
Level of Evidence
Level IIB.
Keywords
distal radius fracture - open reduction internal fixation - tourniquet - outcomes
- no-tourniquet
