Survey of Tourniquet Use in Orthopaedic Foot and Ankle Surgery

2005 ◽  
Vol 26 (3) ◽  
pp. 208-217 ◽  
Author(s):  
Alastair S.E. Younger ◽  
Timothy P. Kalla ◽  
James A. McEwen ◽  
Kevin Inkpen
Keyword(s):  
Cuff Pressure ◽  
Standard Of Care ◽  
Foot And Ankle ◽  
Occlusion Pressure ◽  
Current Standard ◽  
Breakthrough Bleeding ◽  
Pressure Setting ◽  
Ankle Surgery ◽  
American Orthopaedic ◽  
Limb Occlusion Pressure

Background: Tourniquet technique varies among foot and ankle surgeons, and to establish a standard practice guideline the current standard of care should be examined. Methods: One hundred and forty responses were received after 253 surveys were mailed to American Orthopaedic Foot and Ankle Society (AOFAS) members, concerning type of tourniquets, location, and pressures used. Results: Cuff pressures most commonly used were 301 to 350 mmHg for thigh cuffs (49% of thigh cuff users) and 201 to 250 mmHG for calf and ankle cuffs (52% of calf cuff users, 66% of ankle cuff users). A substantial number of foot and ankle surgeons who use calf and ankle cuffs frequently use pressures above 250 mmHg (41% of calf cuff users, 19% of ankle cuff users). Only 9% use limb occlusion pressure when determining cuff pressure. Conclusion: Based on the existing evidence-based literature these pressures may be higher than necessary for many patients, and increased adoption of optimal pressure setting techniques as reported in the literature may help reduce tourniquet pressures used and risk of tourniquet injury. Respondents reported experiencing or hearing reports of breakthrough bleeding, nerve injury, and skin injuries under the cuff.

scholarly journals Publications Rates for Podium and Poster Presentations from the American Orthopaedic Foot and Ankle Society

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0004
Author(s):  
Benjamin Williams ◽  
Grace Kunas ◽  
Jonathan Deland ◽  
Scott Ellis
Keyword(s):  
Full Text ◽  
Odds Ratio ◽  
Sports Medicine ◽  
Publication Rate ◽  
Foot And Ankle ◽  
Publication Rates ◽  
Ankle Surgery ◽  
Orthopaedic Society ◽  
American Orthopaedic ◽  
Poster Presentations

Category: Other Introduction/Purpose: National orthopaedic meetings are used to disseminate current research. These abstracts are commonly intended to go on to full-text publication in peer-reviewed journals. Several studies have reviewed the abstract to full-text journal publications for orthopaedic society meetings and reported a 34% to 73% publication rate. This has not been studied for the foot and ankle literature. The purpose of this study is to determine the full-text journal publication rates of podium and poster presentations from the American Orthopaedic Foot and Ankle Society (AOFAS) Annual meetings between 2008 and 2012. Methods: All abstracts submitted to and subsequently accepted for podium and poster presentations from the 2008 to 2012 AOFAS annual meetings were compiled from the AOFAS and the published meeting programs. In May 2016, PubMed searches were performed using individual key words in the abstract title with all authors’ names. The results were reviewed for matches to the meeting abstracts with regards to content similarities. Time to full-text publication was recorded. Full-text publication rates for podium and poster presentations were calculated per year. The top journals of publication for podium and poster abstracts were calculated. Continuous data was summarized using mean ± standard deviation and categorical data was summarized using counts and percents. Difference in publication rates between podium and poster presentations was determined by an odds ratio. Results: From 2008 to 2012, 1262 abstracts were submitted to the annual meeting. The overall abstract publication rate was 62.4%: 73.7% for podium abstracts and 55.8% for poster abstracts. Podium presentations were significantly more likely to be published compared to posters (p< 0.0001; odds ratio 2.17, 95% CI, 1.64-2.86). Mean time to publication was 1.53 and 1.37 years for podium and poster presentations, respectively (p=0.124). The three most common journals for published podium abstracts were Foot and Ankle International (FAI) (50.4%), Journal of Bone and Joint Surgery (JBJS) (13.0%) and The American Journal of Sports Medicine (AJSM) (4.3%). For poster abstracts, the three most common journals were: FAI (36.9%), Journal of Foot and Ankle Surgery (9.4%) and Foot and Ankle Specialist (8.5%). Conclusion: Podium abstracts were over two times more likely to be published compared to poster abstracts. The overall full- text publication rate for the AOFAS was one of the higher reported rates compared to other national orthopaedic society meetings. The significance of the high full-text publication rate is unclear; it may reflect the quality of presented material or commitment to publication by the authors. The top journal for podium and poster abstracts was FAI, indicating the presentations’ specialty-focus.

Report on the 1989 American Orthopaedic Foot and Ankle Society Fellow Scholarship

Foot & Ankle ◽  
1992 ◽  
Vol 13 (3) ◽  
pp. 161-166
Author(s):  
Arthur Manoli
Keyword(s):  
Medical Center ◽  
Foot And Ankle ◽  
University Of Washington ◽  
Ankle Surgery ◽  
American Orthopaedic ◽  
Vanderbilt University

In 1989, the American Orthopaedic Foot and Ankle Society, Inc., sponsored a scholarship for a member to return to training to do a fellowship in foot and ankle surgery. The following is the account of Arthur Manoli, II, M.D., who served 3 months with Sigvard T. Hansen, Jr., M.D., at the Harborview Medical Center, University of Washington, Seattle, Washington, and 9 months with Marion C. Harper, M.D., at Vanderbilt University, Nashville, Tennessee.

scholarly journals Investigation of clinically acceptable agreement between two methods of automatic measurement of limb occlusion pressure: a randomised trial

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Luke Hughes ◽  
James McEwen
Keyword(s):  
Standard Error ◽  
Cuff Pressure ◽  
Randomised Trial ◽  
Automatic Measurement ◽  
Lower Limbs ◽  
Occlusion Pressure ◽  
Pneumatic Tourniquet ◽  
Dual Purpose ◽  
Limb Occlusion Pressure ◽  
Acceptable Agreement

Abstract Background Development of automatic, pneumatic tourniquet technology and use of personalised tourniquet pressures has improved the safety and accuracy of surgical tourniquet systems. Personalisation of tourniquet pressure requires accurate measurement of limb occlusion pressure (LOP), which can be measured automatically through two different methods. The ‘embedded LOP’ method measures LOP using a dual-purpose tourniquet cuff acting as both patient sensor and pneumatic effector. The ‘distal LOP’ method measures LOP using a distal sensor applied to the patient’s finger or toe of the operating limb, using photoplethysmography to detect volumetric changes in peripheral blood circulation. The distal LOP method has been used clinically for many years; the embedded LOP method was developed recently with several advantages over the distal LOP method. While both methods have clinically acceptable accuracy in comparison to LOP measured using the manual Doppler ultrasound method, these two automatic methods have not been directly compared. The purpose of this study is to investigate if the embedded and distal methods of LOP measurement have clinically acceptable agreement. The differences in pairs of LOP measurement in the upper and lower limbs of 81 healthy individuals were compared using modified Bland and Altman analysis. In surgery, it is common for cuff pressure to deviate from the pressure setpoint due to limb manipulation. Surgical tourniquet systems utilise a ± 15 mmHg pressure alarm window, whereby if the cuff pressure deviates from the pressure setpoint by > 15 mmHg, an audiovisual alarm is triggered. Therefore, if the difference (bias) ± SE, 95% CI of the bias and SD of differences ± SE in LOP measurement between the embedded and distal methods were all within ±15 mmHg, this would demonstrate that the two methods have clinically acceptable agreement. Results LOP measurement using the embedded LOP method was − 0.81 ± 0.75 mmHg (bias ± standard error) lower than the distal LOP method. The 95% confidence interval of the bias was − 2.29 to 0.66 mmHg. The standard deviation of the differences ± standard error was 10.35 ± 0.49 mmHg. These results show that the embedded and distal methods of LOP measurement demonstrate clinically acceptable agreement. Conclusions The findings of this study demonstrate clinically acceptable agreement between the embedded and distal methods of LOP measurement. The findings support the use of the embedded LOP method of automatic LOP measurement using dual-purpose tourniquet cuffs to enable accurate, effective and simple prescription of personalised tourniquet cuff pressures in a clinical setting.

A 5-Year Review of Clinical Outcome Measures Published in the Journal of the American Podiatric Medical Association and the Journal of Foot and Ankle Surgery

2017 ◽  
Vol 107 (3) ◽  
pp. 176-179 ◽  
Author(s):  
Todd Hasenstein ◽  
Timothy Greene ◽  
Andrew J. Meyr
Keyword(s):  
Medical Association ◽  
Clinical Outcome ◽  
Outcome Measures ◽  
Short Form ◽  
Outcome Measurement ◽  
Time Frame ◽  
Original Research ◽  
Foot And Ankle ◽  
Ankle Surgery ◽  
American Orthopaedic

This investigation presents a review of all of the clinical outcome measures used by authors and published in the Journal of the American Podiatric Medical Association and the Journal of Foot and Ankle Surgery from January 1, 2011, to December 31, 2015. Of 1,336 articles published during this time frame, 655 (49.0%) were classified as original research and included in this analysis. Of these 655 articles, 151 (23.1%) included at least one clinical outcome measure. Thirty-seven unique clinical outcome scales were used by authors and published during this period. The most frequently reported scales in the 151 included articles were the American Orthopaedic Foot and Ankle Society scales (54.3%; n = 82), visual analog scale (35.8%; n = 54), Medical Outcomes Study Short Form Health Survey (any version) (10.6%; n = 16), Foot Function Index (5.3%; n = 8), Maryland Foot Score (4.0%; n = 6), and Olerud and Molander scoring system (4.0%; n = 6). Twenty-four articles (15.9%) used some form of original/subjective measure of patient satisfaction/expectation. The results of this investigation detail the considerable variety of clinical outcome measurement tools used by authors in the Journal of the American Podiatric Medical Association and the Journal of Foot and Ankle Surgery and might support the need for a shift toward the consistent use of a smaller number of valid, reliable, and clinically useful scales in the podiatric medical literature.

scholarly journals Lower tourniquet cuff pressure reduces postoperative thigh pain in obese patients undergoing total knee arthroplasty

2019 ◽  
Vol 5 (3) ◽  
pp. 368
Author(s):  
Wenxian Png ◽  
Wuchean Lee ◽  
Mann Hong Tan
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Cuff Pressure ◽  
Thigh Pain ◽  
Obese Patients ◽  
Occlusion Pressure ◽  
Bloodless Field ◽  
Total Knee ◽  
Limb Occlusion Pressure

<p class="abstract"><strong>Background:</strong> The use of high tourniquet pressures in obese patients undergoing total knee arthroplasty increases the risk of postoperative thromboembolic events and skin complications. Measurement of limb occlusion pressure (LOP) before surgery may lead to the use of lower tourniquet cuff pressure during surgery and thereby reduce the risk of postoperative pain and complications.</p><p class="abstract"><strong>Methods:</strong> Eighty-six obese patients scheduled for total knee arthroplasty were randomized to a control group (n=43) with tourniquet pressures at 300 mmHg or the LOP group (n=43) where a recommended tourniquet pressure was determined based on the patient’s limb occlusion pressure. The primary outcome measure was postoperative thigh pain; the secondary outcome measures were the quality of bloodless field, postoperative drop in haemoglobin, postoperative complications and Oxford knee scores.<strong></strong></p><p class="abstract"><strong>Results:</strong> The tourniquet cuff pressure was significantly lower in the LOP group than in the control group (p&lt;0.001). Patients in the LOP group showed significantly lower postoperative thigh pain scores till postoperative day 3. Our study did not show any difference in intraoperative quality of bloodless field (p&lt;0.103), postoperative complications and Oxford knee scores (p&lt;0.775) at six months after surgery.</p><p><strong>Conclusions:</strong> Our results show that the use of limb occlusion pressure method results in decreased postoperative thigh pain without reducing the quality of the bloodless field. We believe that this method in tourniquet application is safe and beneficial for the subset of obese patients undergoing total knee arthroplasty. </p>

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