RESUMO
BACKGROUND: Pneumatic tourniquets are frequently employed in extremity surgeries, aiming to enhance intraoperative visibility and minimize blood loss. Although their benefits and drawbacks have been extensively studied in lower limb operations, their impact on upper limb procedures, particularly elbow surgery, remains poorly understood. This study investigates the advantages and risks associated with pneumatic tourniquet used in elbow surgery. METHODS: A retrospective analysis was conducted on 183 patients who underwent elbow surgery for fractures between January 2019 and September 2023. Patients were categorized into 2 groups: those who underwent surgery with a tourniquet (WT) and those without a tourniquet (NT). Subgroup analyses were performed based on fracture complexity. Data collected included patient characteristics, tourniquet usage, surgical duration, pre- and postoperative hemoglobin levels, C-reactive protein levels, pain assessments, opioid administration, hospital stay duration, follow-up, complications, and revisions. Statistical analyses were used to identify significant differences and correlations. RESULTS: The use of a tourniquet in elbow surgery yielded several notable outcomes. Patients in the WT group experienced significantly shorter surgical durations and hospital stays. Hemoglobin drop was lower in the WT group, indicating reduced blood loss. However, there were no significant differences in postoperative pain, opioid consumption, or complications between the WT and NT groups. Subgroup analysis revealed that the recorded differences, particularly shorter surgical durations, were more pronounced in complex fractures. CONCLUSIONS: This study shows promising results in the use of pneumatic tourniquets in elbow surgery in terms of enhanced efficiency, reduced blood loss, and overall safety, without compromising patient outcomes. However, the potential influence of perioperative decision-making on tourniquet usage underscores the need for further research to elucidate its role and optimize its application, especially in complex elbow fractures.
RESUMO
BACKGROUND: C-reactive protein (CRP)- and leukocyte levels are common parameters to evaluate the inflammatory response after orthopaedic surgery and rule out infectious complications. Nevertheless, both parameters are vulnerable to disturbing biases and therefore leave room for interpretation. OBJECTIVE: Since blood groups are repeatedly discussed to influence inflammatory response, our aim was to observe their impact on CRP and leukocyte levels after total hip and knee arthroplasty (THA/TKA). METHODS: Short term postoperative CRP and leukocyte levels of 987 patients, who received either primary TKH (n= 479) or THA (n= 508), were retrospectively correlated with their blood group. ABO, Rhesus and a combination of both blood groups were differentiated. RESULTS: CRP levels after TKA were significantly higher in blood type AB than in type A and O on day 2-4 and also than in type A on day 6-8. Leukocyte levels after THA were significantly higher in blood group type O than in type A on day 6-8 while still remaining in an apathological range. We observed no significant differences between Rhesus types and Rhesus types and CRP or leukocyte levels. CONCLUSION: We observed significantly increased CRP levels after TKA in patients with blood group AB. Since the elevated CRP levels do not account for early periprosthetic infection, surgeons should include this variation in their postoperative evaluation.