Tourniquet use in lower limb fracture surgery: a systematic review and meta-analysis

  • Martin Præstegaard
  • Elin Beisvåg
  • Julie Ladeby Erichsen
  • Michael Brix
  • Bjarke VibergEmail author
Original Article • LOWER LIMB - FRACTURES



Tourniquets are commonly used in today’s orthopaedic surgical practice, but little evidence is available regarding the links between the use of a tourniquet and the amount of post-operative pain and other complications. The aim of the study was to conduct a systematic review and meta-analysis comparing tourniquet versus non-tourniquet use during fracture surgery of the lower limb in adult patients.


A search was performed using the keyword “tourniquet” in EmBase and as a MeSH term in PubMed, and no limitations (including language) were applied. Available studies were screened using the Covidence software, and demographic as well as outcome data were extracted from the final studies. Critical appraisal was performed according to Cochrane Risk of Bias guidelines. Pooled data were assessed for heterogeneity using Chi-squared and I2 tests.


Five studies were included, and no statistically significant difference was found in the amount of pain and post-operative complications between tourniquet and non-tourniquet groups. Length of in-hospital stay was longer in the tourniquet groups. An overall high risk of bias was found in the included studies.


Although the validity and statistical strength of our results are not strong enough to suggest a change in practice in tourniquet use, the operating surgeon should still carefully consider his or her decision to use a tourniquet in lower limb fracture surgery, as there are indeed complications associated with it and no current evidence to support its continued use.

Level of evidence

Level I, systematic review of randomized controlled trials.


Tourniquet Fracture Lower limb Complication Pain 



The authors thank the library search technicians at the library at Odense Universitetshospital for their assistance in gathering material.

Compliance with ethical standards

Conflict of interest

All authors declare that no financial or personal relationships with other people or organisations exist that could inappropriately influence the work in this study.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery and TraumatologyKolding Hospital – Part of Hospital LillebaeltKoldingDenmark
  2. 2.Department of Orthopaedic Surgery and TraumatologyOdense University HospitalOdenseDenmark
  3. 3.Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
  4. 4.Department of Regional Health ResearchUniversity of Southern DenmarkOdenseDenmark

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