{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:47:56Z","timestamp":1787755676509,"version":"build-2784847793"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,5,19]]},"abstract":"<jats:title>Update<\/jats:title>\n                  <jats:p>This article was updated on September 24, 2021, because of a previous error. On page 864, in the final rowof Tables III and IV,text that had read \u201cGustilo Type IIIA and tourniquet use\u201d now reads \u201cGustilo Type IIIB and tourniquet use.\u201d.<\/jats:p>\n                  <jats:p>An erratum has been published: J Bone Joint Surg Am. 2021 November 3;103(21):e88.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>We sought to evaluate whether tourniquet use, with the resultant ischemia and reperfusion, during surgical treatment of an open lower-extremity fracture was associated with an increased risk of complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This is a retrospective cohort study of 1,351 patients who had an open lower-extremity fracture at or distal to the proximal aspect of the tibia and who participated in the FLOW (Fluid Lavage of Open Wounds) trial. The independent variable was intraoperative tourniquet use, and the primary outcome measures were adjudicated unplanned reoperation within 1 year of the injury and adjudicated nonoperative wound complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Unplanned reoperation and nonoperative wound complications were roughly even between the no-tourniquet (18.7% and 19.1%, respectively) and tourniquet groups (17.8% and 20.8%) (p = 0.78 and p = 0.52). Following matching, as determined by model interactions, tourniquet use was a significant predictor of unplanned reoperation in Gustilo Type-IIIA (odds ratio, 3.60; 95% confidence interval, 1.16 to 11.78) and IIIB fractures (odds ratio, 16.61; 95% confidence interval, 2.15 to 355.40).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The present study showed that tourniquet use did not influence the likelihood of complications following surgical treatment of an open lower-extremity fracture. However, in cases of severe open fractures, tourniquet use was associated with increased odds of unplanned reoperation; surgeons should be cautious with regard to tourniquet use in this setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.20.01458","type":"journal-article","created":{"date-parts":[[2021,4,21]],"date-time":"2021-04-21T02:36:23Z","timestamp":1618972583000},"page":"860-868","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Effect of Tourniquet Use During Surgical Treatment of Open Fractures"],"prefix":"10.2106","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8649-7385","authenticated-orcid":false,"given":"Ida Leah","family":"Gitajn","sequence":"first","affiliation":[{"name":"Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4643-3827","authenticated-orcid":false,"given":"Paul M.","family":"Werth","sequence":"additional","affiliation":[{"name":"Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1466-8063","authenticated-orcid":false,"given":"Sheila","family":"Sprague","sequence":"additional","affiliation":[{"name":"McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3505-1396","authenticated-orcid":false,"given":"Sofia","family":"Bzovsky","sequence":"additional","affiliation":[{"name":"McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1238-3814","authenticated-orcid":false,"given":"Brad A.","family":"Petrisor","sequence":"additional","affiliation":[{"name":"McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3603-3344","authenticated-orcid":false,"given":"Kyle J.","family":"Jeray","sequence":"additional","affiliation":[{"name":"Prisma Health, Greenville, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0537-3474","authenticated-orcid":false,"given":"Nathan N.","family":"O\u2019Hara","sequence":"additional","affiliation":[{"name":"University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3556-9179","authenticated-orcid":false,"given":"Mohit","family":"Bhandari","sequence":"additional","affiliation":[{"name":"McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9111-9239","authenticated-orcid":false,"given":"Gerard","family":"Slobogean","sequence":"additional","affiliation":[{"name":"University of Maryland School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the FLOW Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,3,11]]},"reference":[{"key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1471-2482-12-17","article-title":"Safety and efficacy of a new tourniquet system","volume":"12","author":"Sato","year":"2012","journal-title":"BMC Surg."},{"issue":"1","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1053\/j.jfas.2018.08.023","article-title":"Effect on hospital length of stay of tourniquet use during internal fixation of ankle fractures: randomized controlled trial","volume":"58","author":"Sim","year":"2019","journal-title":"J Foot Ankle Surg."},{"issue":"6","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1046\/j.1365-2044.2001.01982.x","article-title":"The arterial tourniquet: pathophysiological consequences and anaesthetic implications","volume":"56","author":"Kam","year":"2001","journal-title":"Anaesthesia."},{"issue":"1","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.fas.2009.03.006","article-title":"The efficacy of the tourniquet in foot and ankle surgery? 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