Distal Radius Fracture Fixation Using a Tourniquet versus Local Lidocaine with Epinephrine: A Prospective Randomized Trial

Abstract Our objective was to determine the effect of a tourniquet on postoperative pain and function following open reduction and internal fixation (ORIF) of the distal radius. We hypothesized that patients treated with local lidocaine and epinephrine and no-tourniquet would have improved postoperative pain and function when compared with patients treated with standard tourniquet use. This was a prospective, blinded randomized trial of 35 patients aged 18 to 85 who sustained acute closed distal radius fractures treated with a volar plate. Randomization placed 16 patients in the “tourniquet” group and 19 in the “no-tourniquet” group. Lidocaine with epinephrine was used to lessen operative bleeding in the no-tourniquet group. Each patient was assessed preoperatively and at 2 weeks, 6 weeks, and 3 months postoperatively. Patient-reported outcomes included Numerical Rating Scale (NRS) pain score, Patient-Reported Wrist and Hand Evaluation (PRWHE), Patient-Reported Outcome Measurement Information System (PROMIS) pain interference and physical function scores, and QuickDASH scores. Secondary outcomes included estimated blood loss and quality of visualization as assessed by the operating surgeon. The no-tourniquet group demonstrated significantly improved PRWHE function scores at 6 weeks when compared with the tourniquet group. The no-tourniquet group also demonstrated significantly improved PRWHE pain scores from preoperatively to 2 weeks, whereas the tourniquet group did not. There were no other significant differences in NRS pain scores, PRWHE total scores, PROMIS pain interference, PROMIS physical function scores, or QuickDash scores between the two groups. There was no difference in operative time between the two groups. Estimated blood loss was similar between both the groups. There was a difference in subjective visualization favoring tourniquet use, with one patient in the no-tourniquet group crossing over to the tourniquet group because of poor visualization. ORIF of distal radius fractures without a tourniquet and with lidocaine/epinephrine is safe and effective and may contribute to early improvements in function and pain without prolonging operative time or increasing blood loss. Level IIB.