Abstract：Objective To investigate the effect of low tourniquet on ankle fracture surgery. Methods The data of 44 patients with ankle fracture (21 males and 23 females) who were admitted between April 2018 and May 2020 in Tongji Hospital Affiliated to Tongji University were retrospectively analyzed. The patients were aged 18-57 years (average of 42.8 years). The patients were equally divided into two groups, namely, the high and low tourniquet groups, according to the location of tourniquet binding. Both groups were treated with open reduction and internal fixation. Operation time, tourniquet time, intraoperative and postoperative bleeding, and complications (ecchymosis, soft tissue mass, blister, skin ulcer, and lower extremity deep venous thrombosis) were also observed. Pain in the affected limb was evaluated by visual analog scale (VAS) on the 1st, 3rd, 7th, and 14th days after operation. Ankle flexion, back extension, ankle range of motion, and ankle-hindfoot function with American Orthopedic Foot and Ankle Association (AOFAS) score were observed for 4 weeks, 12 weeks, 6 months, and 12 months postoperatively. Results The operation was successfully completed in both groups. No significant differences in operation time, tourniquet time, and bleeding volume were observed (all P values >0.05). In the high tourniquet group, one case of ecchymosis at the tourniquet compression site, one case of soft tissue mass, and one case of deep venous thrombosis were found by color Doppler ultrasonography. No related complications occurred in the low tourniquet group. No significant differences in the VAS scores of limb pain between the two groups were noted on the 1st, 3rd, and 7th days after operation (all P values >0.05). On the 14th day after operation, the VAS score of the low tourniquet group was lower than that of the high tourniquet group (t=2.41, P=0.020). All patients were followed up for 6-24 months with an average of 15.8 months. During follow-up, incisions in the two groups had no infection and healed. No complications, such as loosening and fracture of the internal fixation, occurred. No significant difference in fracture healing time was found between the two groups (t=0.94, P=0.351). At 4 weeks after operation, the ankle flexion, back extension, ankle range of motion, and AOFAS ankle hindfoot score of the low tourniquet group were significantly higher than those in the high tourniquet group (all P values < 0.05). No significant differences in ankle flexion, back extension, ankle range of motion, and AOFAS ankle-hindfoot score were found between the two groups at 12 weeks, 6 months, and 12 months after operation (all P values >0.05). Conclusion The application of low tourniquet in ankle fracture surgery can ensure a good operation interface, improve the early range of motion and clinical function of the ankle joint after operation, and reduce the occurrence of limb pain and related complications caused by traditional tourniquet. Thus, low tourniquet is a new method worthy of recommendation.
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Yao Ying, You Chunfang, Zhou Lyuyi, Fan Jian, Yu Guangrong. Effect of low tourniquet on ankle fracture surgery. Chinese Journal of Anatomy and Clinics, 2022, 27(4): 242-246.
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2022, Vol. 27 
