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Use of the HemaClear™ elastic tourniquet reduces blood loss in operative treatment of humeral shaft fractures

Published:November 08, 2022DOI:https://doi.org/10.1016/j.injury.2022.11.007

      Highlights

      • Use of the elastic tourniquet resulted in 47% less blood loss in our study population.
      • The elastic tourniquet was able to be applied for a longer period of time (67% longer).
        Use of an elastic tourniquet is a viable adjunct in the treatment of humerus shaft fracture.

      Abstract

      Background

      To determine if the use of a narrower elastic tourniquet compared to a standard pneumatic tourniquet reduces operative blood loss in the operative fixation of humeral shaft fractures.

      Methods

      This retrospective cohort study was performed at a level I trauma center and included 134 patients, aged 18 to 90 years, with a humeral shaft fracture treated with open reduction internal fixation (ORIF) from January 2007 through June 2018. The primary variable of interest was the application of a HemaClear™ elastic tourniquet versus a standard pneumatic tourniquet during the fixation of a humeral shaft fracture. The primary outcome was estimated blood loss (EBL) during the humerus ORIF surgery as recorded in the operative record. The secondary outcomes were total tourniquet time and operative time. The primary purpose of the study was to compare the above outcomes between the two tourniquet types.

      Results

      Estimated blood loss was 42% lower (95% CI: 11% to 73%, p < 0.01) in the elastic tourniquet group when compared to the standard pneumatic tourniquet group. The use of the elastic tourniquet was also associated with a 67% increase (95% CI: 35% to 100%, p < 0.01) in tourniquet time compared to the standard pneumatic tourniquet. No difference in the total operative time between the two groups (difference, -3%; 95% CI: -21 to 14, p = 0.72) was observed.

      Conclusion

      Elastic tourniquet use was associated with 42% less blood loss in the fixation of humeral shaft fractures compared to use of a traditional pneumatic tourniquet, although this may be of unclear clinical importance given the relatively low estimated blood loss in this cohort. The potential benefit of reduced blood loss associated with the narrower elastic tourniquet is likely caused by the increased tourniquet time, without a change in overall operative time.

      Keywords

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      References

        • Seo J.B.
        • Heo K.
        • Yang J.H.
        • Yoo J.S.
        Clinical outcomes of dual 3.5-mm locking compression plate fixation for humeral shaft fractures: comparison with single 4.5-mm locking compression plate fixation.
        J Orthop Surg (Hong Kong). 2019; 272309499019839608https://doi.org/10.1177/2309499019839608
        • Bisaccia M.
        • Meccariello L.
        • Rinonapoli G.
        • Rollo G.
        • Pellegrino M.
        • Schiavone A.
        • et al.
        Comparison of plate, nail and external fixation in the management of diaphyseal fractures of the humerus.
        Med Arch. 2017; 71: 97-102https://doi.org/10.5455/medarh.2017.71.97-102
        • Norman D.
        • Greenfield I.
        • Ghrayeb N.
        • Peled E.
        • Dayan L.
        Use of a new exsanguination tourniquet in internal fixation of distal radius fractures.
        Tech Hand Up Extrem Surg. 2009; 13: 173-175https://doi.org/10.1097/BTH.0b013e3181b56187
        • Drosos G.I.
        • Ververidis A.
        • Stavropoulos N.I.
        • Mavropoulos R.
        • Tripsianis G.
        • Kazakos K.
        Silicone ring tourniquet versus pneumatic cuff tourniquet in carpal tunnel release: a randomized comparative study.
        J Orthop Traumatol. 2013; 14: 131-135https://doi.org/10.1007/s10195-012-0223-x
        • Park J.Y.
        • Kim S.E.
        • Lee M.C.
        • Han H.S.
        Elastic pneumatic tourniquet cuff can reduce postoperative thigh pain after total knee arthroplasty: a prospective randomized trial.
        BMC Musculoskelet Disord. 2020; 21: 565https://doi.org/10.1186/s12891-020-03579-6
        • Lee O.S.
        • Lee M.C.
        • Han H.S.
        Efficacy and safety of a new elastic tourniquet cuff in total knee arthroplasty: a prospective randomized controlled study.
        Biomed Eng Online. 2017; 16: 102https://doi.org/10.1186/s12938-017-0393-0
        • Bourquelot P.
        • Levy B.I.
        Narrow elastic disposable tourniquet (Hemaclear®) vs. traditional wide pneumatic tourniquet for creation or revision of hemodialysis angioaccesses.
        J Vasc Access. 2016; 17: 205-209https://doi.org/10.5301/jva.5000520
        • Zlotolow DA
        • Catalano L.W.
        • Barron O.A.
        • Glickel S.Z
        Surgical exposures of the humerus.
        J Am Acad Orthop Surg. 2006; 14 (3rd): 754-765https://doi.org/10.5435/00124635-200612000-00007
        • Gerwin M.
        • Hotchkiss R.N.
        • Weiland A.J.
        Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve.
        J Bone Joint Surg Am. 1996; 78: 1690-1695https://doi.org/10.2106/00004623-199611000-00008
        • González Posada M.A.
        • Biarnés Suñe A.
        • Naya Sieiro J.M.
        Salvadores de Arzuaga CI, Colomina Soler MJ. Damage control resuscitation in polytrauma patient.
        Rev Esp Anestesiol Reanim (Engl Ed). 2019; 66: 394-404https://doi.org/10.1016/j.redar.2019.03.009