Incidence and factors influencing tourniquet pain / 中华创伤杂志(英文版)

PURPOSE@#The use of tourniquet in orthopedic surgery facilitates operation by establishing a bloodless surgical field. However, many complications following the use of tourniquets have been reported. Tourniquet pain is the most common complication. This study aimed to find the actual incidence of pain associated with tourniquet use in orthopedic surgery and the various factors.@*METHODS@#It is a prospective observational study conducted on 132 consecutive cases. Patients aged 18-70 years with musculoskeletal problems of the forearm and leg requiring surgery were included in the study. Patients with open injuries or contraindications such as diabetes mellitus, compromised circulatory states, neurological deficit, compartment syndrome and unable to give informed consent were excluded. The parameters assessed included duration of tourniquet use, tourniquet pressure, type of anesthesia, any interval release of the tourniquet and reapplication after a reperfusion period, whether upper or lower limb surgery, severity of tourniquet pain, timing of tourniquet release and complications. Chi-square and non-parametric Mann-Whitney U test were used for data analysis.@*RESULTS@#In upper limb surgeries, if duration of surgery was less than 60 min, 14 (51.8%) cases experienced tourniquet pain and 13 (48.1%) had no pain, and if duration of surgery was more than 60 min, 24 (60.0%) had pain and 16 (40.0%) experienced no pain. In lower limb surgeries if duration of surgery was less than 60 min, 2 (7.7%) experienced pain and 24 (92.3%) had no pain, and if duration of surgery was more than 60 min, 14 (35.8%) experienced pain and 25 (64.8%) had no pain. Degree of tourniquet pain increases with the duration of surgery. Statistically, there was significant association between tourniquet inflation time and tourniquet pain in both upper and lower limbs (p = 0.034 and 0.024, respectively) CONCLUSION: Incidence of tourniquet pain was in direct proportion to the duration of tourniquet use and was higher in cases with regional anesthesia. Other risk factors assessed including tourniquet pressure, upper or lower limb surgery, tourniquet release time and interval had no significant contribution to the incidence or severity of tourniquet pain.

Arthroscopic, Nonrigid Fixation of a Displaced Glenoid Fracture After Anterior Shoulder Dislocation.

Glenoid rim fractures are recognized as a risk factor for recurrent instability after anterior shoulder dislocation. In addition to traditional open treatments of bony Bankart lesions, several arthroscopic techniques of fixation and reconstruction recently have been described. We present a technique of arthroscopic nonrigid fixation for large glenoid rim fractures, as an alternative to existing procedures.

Arthroscopic Anatomic Glenoid Reconstruction in the Setting of a Failed Latarjet Using Distal Tibial Allograft.

Treatment of traumatic anterior glenohumeral dislocation has evolved over the years in terms of surgical approaches and methods of repair. Recurrence of instability following surgical repair remains challenging with conventional methods of open reconstruction. We describe the utilization of arthroscopic anatomic glenoid reconstruction using a distal tibial allograft after a failed Latarjet procedure. Preoperative and operative methodology are described with relevant imaging investigations and a detailed intraoperative arthroscopic technique.

Editorial Commentary: Dermal Allograft: A Viable Allograft for Salvage Procedures in Treating Irreparable Rotator Cuff Tears.

Our experience with superior capsule reconstruction (SCR) has been successful in patients with isolated, irreparable, supraspinatus tears; however, we have found that bridging reconstruction may have a better role in treating patients with some cuff remnant. Our results are promising, and, although there is new evidence to show that dermal allografts can heal in the setting of rotator cuff deficiency, the basic principle of restoring anatomy should not be ignored. SCR has been accepted as a salvage procedure for irreparable cuff tears, with the precise indications being elucidated. Reconnecting viable cuff muscle to tuberosity directly or through a graft should be considered before SCR.

Hip Arthroscopy for Femoral Acetabular Impingement: A Bird's-Eye/En Face Perspective With Ultrasound Guidance and 3-Dimensional Hip Printing.

Femoral acetabular impingement is a common hip disorder that may prove debilitating to many patients. Surgical management is indicated by way of hip arthroscopy for impinging CAM and pincer acetabular lesions. Traditionally, fluoroscopy has been used for the intraoperative assessment of bony resection; however, many disadvantages include radiation risks, equipment demands, and more. With ultrasound-guided arthroscopy, we describe the use of 1:1 3-dimensional hip printed models through various visual perspectives of impinging lesions. Given the low cost of 3-dimensional hip printing, lack of radiation exposure, and tactile multiangular views, we propose a safer and more reproducible intraoperative technique to conventional fluoroscopy to achieve better resection and outcomes after femoral acetabular impingement surgery.