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Journal of Bone and Joint Surgery - British Volume, Vol 84-B, Issue 4, 492-496.
doi: 10.1302/0301-620X.84B4.12563  
Copyright © 2002 by British Editorial Society of Bone and Joint Surgery
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Friction burns within the tibia during reaming

ARE THEY AFFECTED BY THE USE OF A TOURNIQUET?

P. V. Giannoudis, MD, EEC(Orth), Consultant Orthopaedic Surgeon1; S. Snowden, BSc, Senior Physicist2; S. J. Matthews, FRCS, Consultant Orthopaedic Surgeon1; S. W. Smye, PhD, Director2; and R. M. Smith, MD, FRCS, Professor1

1 Department of Trauma and Orthopaedics
2 Department of Medical Physics, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK.

Correspondence should be sent to Dr P. V. Giannoudis.

We have carried out a prospective, randomised trial to measure the rise of temperature during reaming of the tibia before intramedullary nailing. We studied 34 patients with a mean age of 35.1 years (18 to 63) and mean injury severity score of 10 (9 to 13). The patients were randomised into two groups: group 1 included 18 patients whose procedure was undertaken without a tourniquet and group 2, 16 patients in whom a tourniquet was used. The temperature in the bone was measured directly by two thermocouples inserted into the cortical bone near the isthmus of the tibial diaphysis. Reaming was carried out to at least 1.5 mm above the required diameter of the nail. Blood loss was assessed by recording the preoperative and postoperative haemoglobin (Hb) level.

The minimum clinical follow-up was six months. In group 1 (no tourniquet), the mean Hb dropped 2.8 g/dl from 14.3 ± 1.02 g/dl to 11.5 ± 1.04 g/dl (p = 0.0001), whereas with the tourniquet, the mean decrease was 1.3 g/dl from 14 ± 1 g/dl to 12.7 ± 1.3 g/dl (p = 0.007). This difference was not statistically significant. The mean initial tibial temperature was 35.6°C (SD 0.6) and rose with reaming to levels between 36.3°C and 51.6°C. The highest temperatures were obtained with the largest reamers (11 and 12 mm, p = 0.0001) and the most rapid rise with the smallest diameters of medullary canal (8 or 9 mm). The rise of temperature was transient (20s).

We were unable to identify any effect of the use of a tourniquet on the temperature achieved. Reamed intramedullary tibial nailing induces a transient elevation of temperature which is directly related to the amount of reaming.




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 J Bone Joint Surg BrHome page
H.-C. Pape and P. Giannoudis
The biological and physiological effects of intramedullary reaming
J Bone Joint Surg Br, November 1, 2007; 89-B(11): 1421 - 1426.
[Abstract] [Full Text] [PDF]


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