Lower extremity tourniquet utilization remains a controversial practice during the operative fixation of rotational ankle fractures and is often left to surgeon discretion. At our own institution, tourniquet use varies between surgeons with some providers using a tourniquet for every case, while others regularly do not utilize tourniquets. Despite benefits of decreased surgical time and decreased blood loss, many studies have cited negative outcomes associated with tourniquet usage including increased postoperative swelling and pain, increased wound complications, and increased risks of deep vein thrombosis. These outcomes have been limited to retrospective reviews and meta-analyses with few randomized control trials specifically evaluating these outcomes in ankle fracture patients. To better assess the impact of tourniquet use on ankle fracture postoperative outcomes, this randomized control trial seeks to 1) compare differences in postoperative visual analog scale pain scores for patients undergoing operative fixation of rotation ankle fractures with and without a tourniquet, while 2) evaluating rates of wound, thrombotic, and surgical complications associated with tourniquet use. Patients will be randomized by an Excel random number generator to a tourniquet and non-tourniquet group. Patients will remain blinded to randomization. The treating orthopaedic trauma surgeon will be notified by the PI of the study informing them of the randomization status to ensure appropriate tourniquet utilization the day of surgery. Patients will then undergo standard operative fixation and postoperative management as clinically indicated by the orthopaedic trauma team. Patients will follow-up at 2 weeks and subsequently every 4 weeks as is protocol at our institution. Patient charts will be reviewed for patient and perioperative factors, as well as postoperative complications (i.e. wound complications, need for repeat surgical intervention, and deep vein thrombosis).
Age range
18 Years – 65 Years
Sex
ALL
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A starting point for the conversation — always confirm anything about your own eligibility, costs, and care with the study team and your doctor.
Visual Analog Scale Pain Levels
Timeframe: Post anesthesia recovery unit, 2 weeks postoperatively, 6 weeks, 3 month follow-up
Patient-Reported Outcome Measurement Information System (PROMIS) Cat V1.1 Pain Interference scores
Timeframe: 6 weeks, 3 months
Patient-Reported Outcome Measurement Information System (PROMIS) Cat V2.0 Physical Function Score
Timeframe: 6 weeks, 3 month
Patient-Reported Outcome Measurement Information System (PROMIS) Scale V1.2 Global Health Score
Timeframe: 6 weeks, 3 months
Optimal Screening for Prediction of Referral and Outcome (OSPRO) Yellow Flag 17-Item
Timeframe: 6 weeks, 3 months