MD - PMR ( PHY MED AND REHAB )
MS - ORTHOPAEDICS
FINAL EXAM
Q 1 EXPLAIN IN DETAIL -
A ) WHAT ARE TORNIQUETS ?
B ) TYPES OF TORNIQUETS ?
C ) INDICATIONS AND CONTRAINDICATION OF TORNIQUETS IN ORTHOPAEDIC PRACTICE ?
D ) PARTS OF TORNIQUET ?
E ) COMPLICATIONS OF A TORNIQUET ?
A 1 INTRODUCTION
1 Jean louis petit coined the word torniquet from the french word tourner ( to turn ) in 1718 when he used them for lower limb amputations to reduce blood loss
2 In 1873 , johan friedrich august von esmarch introduced flat rubber tube wrapped repeatedly around the limb as torniquet
3 In 1904 harvard cushing introduced pneumatic torniquet to limb surgery
A ) DEFINITION
A torniquet is a constricting or compressing device used to control venous or arterial circulation to an extremity for a period of time
In this , pressure is applied circumferentially upon the skin and underlying tissues of the limb
B ) TYPES
1 Petit original
2 Esmarch
3 Pneumatic manual
4 Pneumatic microprocessor controlled
II ) TYPES
A ) SURGICAL - prevents blood flow to a limb and enables surgeon to work in a bloodless operative field and are frequently used in orthopaedic surgery
B ) EMERGENCY - used in emergency bleeding control to prevent severe blood loss from traumatized limb
C ) INDICATIONS
1 For Reduction of certain fractures
2 For Kirchner wire removal
3 In Replacement or revision of the joints of knee , wrist , digits , hand or elbow
4 For arthroscopy of knee , elbow , wrist , hand and digits
5 For repair of traumatic nerve damage
6 In bone grafts
7 In subcutaneous fasciotomy
8 In carpal tunnel release
9 In traumatic or non traumatic amputations
10 In correction of hammer toe
CONTRAINDICATIONS
1 Peripheral vascular disease
2 arteriovenous fistula
3 peripheral neuropathy
4 DVT
5 severe infection of the limb
6 severe trauma to the limb
7 poor skin condition of the limb
8 sickle cell hemoglobinopathy
D ) PARTS
1 Inflatable cuff
2 Gas source ( nitrogen or oxygen )
3 Pressure display
4 Pressure regulator ( within 2 - 6 mm hg )
5 Connection tubing
GUIDELINES
1 The pressure source , cuff , regulator , tubing and connectors needed to be checked before use
2 Cuff should be as wide as possible
3 the cuff should not overlie a bony prominence
4 the cuff should overlap atleast 3 inches but not more than 6 inches as it can cause generation of high pressure
5 The extremity should be exanguinated before inflation of torniquet
BRUNER RULES FOR SAFER USE
1 size of torniquet - arm ( 10 cms ) , leg 15 cms
2 site of application - upper arm , upper mid thigh
3 padding - atleast 2 layers of orthopaedic wool
4 time - absolute maximum 3 hrs , generally should not exceed 2 hrs
E ) COMPLICATIONS - DIVIDED INTO 2
1 LOCAL -
A ) Nerve injury ( 0.73 % )
1 Normal physiological conduction block is 15 minutes
2 In this radial nerve is more frequently involved than ulnar and median nerves in upper extremity and sciatic nerve in lower extremity is frequently involved
3 Large diameter nerve fibers are more frequently involved
B ) Muscle injury - Tends to be greater beneath the torniquet because of combination of ischemia and mechanical deformation
Usually normalise within 3 weeks
C ) Vascular injury
D ) Skin injury
E ) Hematoma / bleeding
F ) Torniquet pain -
the smaller unmyelinated C fibers are more resistant to LA induced conduction block as compared to A fibers
2 SYSTEMIC -
A ) Cardiovascular
B ) Respiratory
C ) Cerebral circulatory
D ) Hematological
E ) Temperature changes
F ) Metabolical