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Original Article Does the Use of a Silicone Ring Tourniquet Help Reduce Bleeding in the Minimally Invasive Internal Fixation with Locking Plate for Distal Femoral Fractures?
Ki-Bong Park, Hong-Ki Jin, Il-Yeong Hwang, Sung-Who Chang, Sung-Cheon Na
Journal of Musculoskeletal Trauma 2020;33(3):148-153.
DOI: https://doi.org/10.12671/jkfs.2020.33.3.148
Published online: July 31, 2020
1Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
2Department of Orthopedic Surgery, Good Samsun Hospital, Busan, Korea

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Abstract

Purpose
This study evaluated the usefulness of a silicone ring tourniquet by analyzing the changes in the perioperative hemoglobin (Hb) levels or amount of perioperative bleeding compared to those of a pneumatic tourniquet or no usage during minimally invasive plate fixation for distal femoral fractures.
Materials and Methods
From January 2017 to December 2019, 30 patients who underwent minimally invasive plate fixation using a locking compression plate for distal femoral fractures were evaluated and classified as a silicone ring tourniquet (Group 1), a pneumatic tourniquet (Group 2), and no usage (Group 3). The variables for analysis were age, sex, preoperative Hb (preHb), postoperative 72-hour Hb (postHb), differences between preHb and postHb (preHb-postHb), amount of intraoperative and overall transfusion, estimated unit of transfusion corrected by preHb-postHb and total transfusion (Hb-lost), amount of intraoperative and postoperative and total bleeding. One-way ANOVA was used to identify the differences between the groups.
Results
The age, sex, operation time, preHb, preHb-postHb, amount of intraoperative and overall transfusion and Hb-lost were similar in the two groups. The amount of intraoperative bleeding was significantly lower in Group 1 than Group 3 (p=0.004), but there was no difference in the amount of postoperative and total bleeding between the two groups.
Conclusion
The use of a silicone ring tourniquet in the minimally invasive plate fixation for distal femoral fractures decreased the amount of intraoperative bleeding compared to no use of a tourniquet.


J Korean Fract Soc. 2020 Jul;33(3):148-153. Korean.
Published online Jul 24, 2020.
https://doi.org/10.12671/jkfs.2020.33.3.148
Copyright © 2020 The Korean Fracture Society. All rights reserved.
Original Article

Does the Use of a Silicone Ring Tourniquet Help Reduce Bleeding in the Minimally Invasive Internal Fixation with Locking Plate for Distal Femoral Fractures?

Ki-Bong Park, M.D., Hong-Ki Jin, M.D.,* Il-Yeong Hwang, M.D., Sung-Who Chang, M.D. and Sung-Cheon Na, M.D.
    • Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
    • *Department of Orthopedic Surgery, Good Samsun Hospital, Busan, Korea.
  • Correspondence to: Ki-Bong Park, M.D. Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Korea. Tel: +82-52-250-7129, Fax: +82-52-235-2823, Email: kbpark@uuh.ulsan.kr
Received April 07, 2020; Revised May 20, 2020; Accepted June 16, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study evaluated the usefulness of a silicone ring tourniquet by analyzing the changes in the perioperative hemoglobin (Hb) levels or amount of perioperative bleeding compared to those of a pneumatic tourniquet or no usage during minimally invasive plate fixation for distal femoral fractures.

Materials and Methods

From January 2017 to December 2019, 30 patients who underwent minimally invasive plate fixation using a locking compression plate for distal femoral fractures were evaluated and classified as a silicone ring tourniquet (Group 1), a pneumatic tourniquet (Group 2), and no usage (Group 3). The variables for analysis were age, sex, preoperative Hb (preHb), postoperative 72-hour Hb (postHb), differences between preHb and postHb (preHb-postHb), amount of intraoperative and overall transfusion, estimated unit of transfusion corrected by preHb-postHb and total transfusion (Hb-lost), amount of intraoperative and postoperative and total bleeding. One-way ANOVA was used to identify the differences between the groups.

Results

The age, sex, operation time, preHb, preHb-postHb, amount of intraoperative and overall transfusion and Hb-lost were similar in the two groups. The amount of intraoperative bleeding was significantly lower in Group 1 than Group 3 (p=0.004), but there was no difference in the amount of postoperative and total bleeding between the two groups.

Conclusion

The use of a silicone ring tourniquet in the minimally invasive plate fixation for distal femoral fractures decreased the amount of intraoperative bleeding compared to no use of a tourniquet.

Keywords
Femoral fractures, Internal fracture fixation, Tourniquets, Hemorrhage, Hemoglobins

Figures

Fig. 1
Clinical photographs of a 51-year-old male patient who underwent surgery for distal femoral fracture of the left knee. Pneumatic tourniquet (A) and silicon ring tourniquet (B).

Fig. 2
The length from the superior margin of the patella to the distal margin of the tourniquet was 9.4 cm in pneumatic tourniquet (A) and 15.3 cm in silicon ring tourniquet (B).

Fig. 3
Volume of hemoglobin (Hb) in each group. Pre: preoperative, 72 h: during 72 hours after surgery, Dif: difference with Pre- and 72 h-Hb, SRT: silicone ring tourniquet, PT: pneumatic tourniquet, NPT: no usage of tourniquet. *p<0.05.

Fig. 4
Volume of blood loss in each group. IO: intraoperative, PO: during 72 hours after surgery, SRT: silicone ring tourniquet, PT: pneumatic tourniquet, NPT: no usage of tourniquet. **p<0.01.

Fig. 5
Units of transfusion in each group. IO: intraoperative, 72 h: during 72 hours after surgery, SRT: silicone ring tourniquet, PT: pneumatic tourniquet, NPT: no usage of tourniquet.

Tables

Table 1
Demographic Information and Clinical Features of Patients

Notes

Financial support:None.

Conflict of interests:None.

References

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    Does the Use of a Silicone Ring Tourniquet Help Reduce Bleeding in the Minimally Invasive Internal Fixation with Locking Plate for Distal Femoral Fractures?
    J Korean Fract Soc. 2020;33(3):148-153.   Published online July 31, 2020
    DOI: https://doi.org/10.12671/jkfs.2020.33.3.148
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