{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:22:38Z","timestamp":1759335758771,"version":"3.41.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T00:00:00Z","timestamp":1746576000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009411","name":"Universit\u00e9 Paris-Est Cr\u00e9teil","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009411","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["International Orthopaedics (SICOT)"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>One ongoing debate in orthopaedic surgery concerns using tourniquets in sickle cell trait (SCT) patients. SCT, a heterozygous carrier state of sickle cell disease (SCD), affects an estimated 300\u00a0million individuals globally with various genetic ancestries.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A retrospective cohort study was conducted on 940 SCT patients and 1263 matched non-SCT controls who underwent limb surgeries using tourniquets between 1978 and 2018. Patient data were gathered from hospital records, blood bank information, and postoperative haemoglobin electrophoresis. Outcomes assessed included the incidence of venous thromboembolism (VTE), pulmonary embolism (PE), phlebitis, peripheral nerve impairment, and superficial infection. Covariates included age, sex, ethnicity, and diabetes status.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Among SCT patients, 75% were unaware of their carrier status at surgery. VTE incidence was significantly higher in SCT patients (10%) than non-SCT controls (2%), especially after prolonged tourniquet use and in upper limb procedures without anticoagulation. PE occurred in 3% of SCT patients, versus 1% in controls. Diabetes, more prevalent in SCT individuals (9% vs. 6%), further increased the complication risk. Tourniquet inflation time did not differ significantly between groups; however, neurologic complications and phlebitis were more common in SCT patients, particularly those with Mediterranean ancestry. Notably, SCT carriers of African and Mediterranean descent experienced higher complication rates than non-carriers, though complications were not confined to any single ancestry.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>SCT is associated with an increased risk of thrombotic and neurologic complications during tourniquet, particularly in patients with undiagnosed SCT or diabetes and in procedures with extended ischaemia time. These results confirm the perception of SCT as a benign condition, but call for further clinical guidelines regarding tourniquet use in SCT carriers.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00264-025-06555-8","type":"journal-article","created":{"date-parts":[[2025,5,7]],"date-time":"2025-05-07T06:23:35Z","timestamp":1746599015000},"page":"1607-1614","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Tourniquet use in patients with sickle cell trait (SCT): Mediterranean or African ancestry influences complications, demonstrating a higher prevalence than control patients: matched study of nine hundred and forty SCT versus one thousand, two hundred and sixty three non-SCT patients"],"prefix":"10.1007","volume":"49","author":[{"given":"Philippe","family":"Hernigou","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Vedrenne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sami","family":"Karam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles Henri","family":"Flouzat-Lachaniette","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,7]]},"reference":[{"key":"6555_CR1","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.3324\/haematol.2018.206060","volume":"104","author":"JZ Xu","year":"2019","unstructured":"Xu JZ, Thein SL (2019) The carrier state for sickle cell disease is not completely harmless. Haematologica 104:1106\u20131111","journal-title":"Haematologica"},{"key":"6555_CR2","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.19669","author":"P Ellsworth","year":"2024","unstructured":"Ellsworth P, Pawlinski IJ, Sielaty R, Ilich A, Prokopenko Y, Moonla C et al (2024) Hypertonicity and\/or acidosis induce marked rheological changes under hypoxic conditions in sickle trait red blood cells. Br J Haematol https:\/\/doi.org\/10.1111\/bjh.19669","journal-title":"Br J Haematol"},{"key":"6555_CR3","doi-asserted-by":"crossref","unstructured":"Fr\u00f6mmel C, Brose A, Klein J, Blankenstein O, Lobitz S (2014) Newborn Screening for Sickle Cell Disease: Technical and Legal Aspects of a German Pilot Study with 38,220 Participants. Biomed Res. Int., 2014, 695828","DOI":"10.1155\/2014\/695828"},{"key":"6555_CR4","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1038\/ncomms1104","volume":"1","author":"FB Piel","year":"2010","unstructured":"Piel FB, Patil AP, Howes RE, Nyangiri OA, Gething PW, Williams TN, Weatherall DJ, Hay SI (2010) Global distribution of the sickle cell gene and geographical confirmation of the malaria hypothesis. Nat Commun 1:104","journal-title":"Nat Commun"},{"key":"6555_CR5","doi-asserted-by":"publisher","first-page":"e128","DOI":"10.1371\/journal.pmed.0020128","volume":"2","author":"TN Williams","year":"2005","unstructured":"Williams TN, Mwangi TW, Roberts DJ, Alexander ND, Weatherall DJ, Wambua S, Kortok M, Snow RW, Marsh K (2005) An immune basis for malaria protection by the sickle cell trait. PLoS Med 2:e128","journal-title":"PLoS Med"},{"key":"6555_CR6","doi-asserted-by":"publisher","first-page":"2045","DOI":"10.1249\/MSS.0b013e31826851c2","volume":"44","author":"FG O\u2019Connor","year":"2012","unstructured":"O\u2019Connor FG, Bergeron MF, Cantrell J, Connes P, Harmon KG, Ivy E et al (2012) ACSM and CHAMP summit on sickle cell trait: mitigating risks for warfighters and athletes. Med Sci Sports Exerc 44:2045\u20132056","journal-title":"Med Sci Sports Exerc"},{"key":"6555_CR7","doi-asserted-by":"publisher","first-page":"2115","DOI":"10.1001\/jama.2014.15063","volume":"312","author":"RP Naik","year":"2014","unstructured":"Naik RP, Derebail VK, Grams ME, Franceschini N, Auer PL, Peloso GM et al (2014) Association of sickle cell trait with chronic kidney disease and albuminuria. Afr Americans JAMA 312:2115\u20132125","journal-title":"Afr Americans JAMA"},{"issue":"2","key":"6555_CR8","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1080\/17474086.2017.1273765","volume":"10","author":"M Pignatti","year":"2017","unstructured":"Pignatti M, Zanella S, Borgna-Pignatti C (2017) Can the surgical tourniquet be used in patients with sickle cell disease or trait? A review of the literature. Expert Rev Hematol Feb 10(2):175\u2013182. https:\/\/doi.org\/10.1080\/17474086.2017.1273765","journal-title":"Expert Rev Hematol Feb"},{"issue":"8","key":"6555_CR9","doi-asserted-by":"publisher","first-page":"e279","DOI":"10.1016\/j.amjmed.2022.03.024","volume":"135","author":"J Hulsizer","year":"2022","unstructured":"Hulsizer J, Resurreccion WK, Shi Z, Wei J, Ladson-Gary S, Zheng SL, Helfand BT, Billings L, Caplan MS, Xu J (2022) Sickle cell trait and risk for common diseases: evidence from the UK biobank. Am J Med Aug 135(8):e279\u2013e287. https:\/\/doi.org\/10.1016\/j.amjmed.2022.03.024","journal-title":"Am J Med Aug"},{"key":"6555_CR10","doi-asserted-by":"publisher","unstructured":"Hernigou P (2025) Procedures under tourniquet in sickle cell disease: safety evaluated in two hundred and Thirty three sickle-cell disease anaemia adult patients in comparison with outcomes in five hundred and Seventy four sickle cell anaemia patients with procedures without tourniquet. Int Orthop Apr 7. https:\/\/doi.org\/10.1007\/s00264-025-06510-7","DOI":"10.1007\/s00264-025-06510-7"},{"key":"6555_CR11","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1001\/archsurg.1972.04180020070013","volume":"104","author":"AE Flatt","year":"1972","unstructured":"Flatt AE (1972) Tourniquet time in hand surgery. Arch Surg 104:190\u2013192","journal-title":"Arch Surg"},{"key":"6555_CR12","doi-asserted-by":"crossref","unstructured":"Naik RP, Haywood C (2015) Sickle cell trait diagnosis: clinical and social implications. Hematology, pp 160\u2013167","DOI":"10.1182\/asheducation-2015.1.160"},{"key":"6555_CR13","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/j.amjmed.2008.12.020","volume":"122","author":"G Tsaras","year":"2009","unstructured":"Tsaras G, Owusu-Ansah A, Boateng FO, Amoateng-Adjepong Y (2009) Complications associated with sickle cell trait: A brief narrative review. Am J Med 122:507\u2013512","journal-title":"Am J Med"},{"key":"6555_CR14","first-page":"232596712094249","volume":"8","author":"BP Boden","year":"2020","unstructured":"Boden BP, Fine KM, Breit I, Lentz W, Anderson SA (2020) Nontraumatic exertional fatalities in football players, part 1: epidemiology and effectiveness of National collegiate athletic association bylaws. Orthop J Sport Med 8:232596712094249","journal-title":"Orthop J Sport Med"},{"key":"6555_CR15","first-page":"232596712094349","volume":"8","author":"BP Boden","year":"2020","unstructured":"Boden BP, Fine KM, Spencer TA, Breit I, Anderson SA (2020) Nontraumatic exertional fatalities in football players, part 2: excess in conditioning kills. Orthop J Sport Med 8:232596712094349","journal-title":"Orthop J Sport Med"},{"key":"6555_CR16","first-page":"1156","volume":"103","author":"B Fisher","year":"2010","unstructured":"Fisher B, Roberts CS (2010) Tourniquet use and sickle cell hemoglobinopathy: how should we proceed? South. Med J 103:1156\u20131160","journal-title":"Med J"},{"key":"6555_CR17","first-page":"3","volume":"25","author":"LM Oginni","year":"1996","unstructured":"Oginni LM, Rufai MB (1996) How safe is tourniquet use in sickle-cell disease? Afr. J Med Med Sci 25:3\u20136","journal-title":"J Med Med Sci"},{"key":"6555_CR18","doi-asserted-by":"publisher","first-page":"38","DOI":"10.7547\/87507315-74-1-38","volume":"74","author":"JS Willinsky","year":"1984","unstructured":"Willinsky JS, Lepow R (1984) Sickle cell trait and use of the pneumatic tourniquet. A case report. J Am Podiatry Assoc 74:38\u201341","journal-title":"J Am Podiatry Assoc"},{"key":"6555_CR19","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1097\/00003086-198009000-00033","volume":"151","author":"RE Stein","year":"1980","unstructured":"Stein RE, Urbaniak J (1980) Use of the tourniquet during surgery in patients with sickle cell hemoglobinopathies. Clin Orthop Relat Res 151:231\u2013233","journal-title":"Clin Orthop Relat Res"},{"key":"6555_CR20","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1093\/bja\/37.8.614","volume":"37","author":"A Gilbertson","year":"1965","unstructured":"Gilbertson A (1965) Anaesthesia in West African patients with sickle-cell anaemia, haemoglobin SC disease, and sickle-cell trait. Brit J Anaesth 37:614\u2013622","journal-title":"Brit J Anaesth"},{"key":"6555_CR21","doi-asserted-by":"publisher","first-page":"291","DOI":"10.7547\/87507315-74-6-291","volume":"74","author":"WJ Martin","year":"1984","unstructured":"Martin WJ, Green DR, Dougherty N et al (1984) Tourniquet use in sickle cell disease patients. J Am Podiatry Assoc 74:291\u2013294","journal-title":"J Am Podiatry Assoc"},{"key":"6555_CR22","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1007\/BF03009313","volume":"40","author":"Y Adu-Gyamfi","year":"1993","unstructured":"Adu-Gyamfi Y, Sankarankutty M, Marwa S (1993) Use of a tourniquet in patients with sickle-cell disease. Can J Anaesth 40:24\u201327","journal-title":"Can J Anaesth"},{"key":"6555_CR23","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1213\/01.ANE.0000130915.21093.56","volume":"99","author":"JM Sarjeant","year":"2004","unstructured":"Sarjeant JM, Callum JL (2004) The use of tourniquets in patients with sickle cell disease. Anesth Analg 99:630","journal-title":"Anesth Analg"},{"key":"6555_CR24","doi-asserted-by":"publisher","unstructured":"Hernigou P, Homma Y, Bastard C, Yoon BC, Lachaniette CF (2025) Subtrochanteric shortening osteotomy in adult sickle cell disease patients with cemented total hip arthroplasty for hip deformities secondary to childhood osteonecrosis: is healing a challenge? Int orthop. 49(2):407\u2013419. https:\/\/doi.org\/10.1007\/s00264-024-06394-z","DOI":"10.1007\/s00264-024-06394-z"},{"issue":"4","key":"6555_CR25","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1007\/s00264-023-06049-5","volume":"48","author":"AA Mughalles","year":"2024","unstructured":"Mughalles AA, Alkholidy GG, AlSaifi MS, Al-Gabaly WM, Al-Haddad KM (2024) Total hip replacement among sickle cell patients in a low-income country-Yemen. Int Orthop Apr 48(4):923\u2013930. https:\/\/doi.org\/10.1007\/s00264-023-06049-5","journal-title":"Int Orthop Apr"},{"issue":"12","key":"6555_CR26","doi-asserted-by":"publisher","first-page":"2941","DOI":"10.1007\/s00264-023-05886-8","volume":"47","author":"M Ouederni","year":"2023","unstructured":"Ouederni M, Rouag H, Ben Fraj I, Rekaya S, Kouki R, Lamouchi T, Zaiter I, Mellouli F, Bejaoui M, Ben Khaled M (2023) Incidence and risk factors for osteonecrosis of the femoral head in five hundred and ten sickle cell disease paediatric patients. Int Orthop Dec 47(12):2941\u20132952. https:\/\/doi.org\/10.1007\/s00264-023-05886-8","journal-title":"Int Orthop Dec"},{"issue":"3","key":"6555_CR27","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1007\/s00264-022-05631-7","volume":"47","author":"P Hernigou","year":"2023","unstructured":"Hernigou P (2023) Revisiting prediction of collapse in hip osteonecrosis with artificial intelligence and machine learning: a new approach for quantifying and ranking the contribution and association of factors for collapse. Int Orthop Mar 47(3):677\u2013689. https:\/\/doi.org\/10.1007\/s00264-022-05631-7","journal-title":"Int Orthop Mar"}],"container-title":["International Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-025-06555-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00264-025-06555-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00264-025-06555-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T15:02:11Z","timestamp":1750431731000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00264-025-06555-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,7]]},"references-count":27,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["6555"],"URL":"https:\/\/doi.org\/10.1007\/s00264-025-06555-8","relation":{},"ISSN":["0341-2695","1432-5195"],"issn-type":[{"type":"print","value":"0341-2695"},{"type":"electronic","value":"1432-5195"}],"subject":[],"published":{"date-parts":[[2025,5,7]]},"assertion":[{"value":"21 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 May 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was performed in line with the principles of the Declara\u00adtion of Helsinki. Informed consent was waived due to the retrospective design of the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}