Feasibility of Distal Radius Fracture Fixation With or Without a Tourniquet Under General or Regional Anesthesia: A Retrospective Comparative Study

Background Tourniquets provide a bloodless field but may increase ischemic complications and postoperative pain. We compared perioperative and clinical outcomes of distal radius fracture (DRF) fixation with versus without a tourniquet under general or regional anesthesia. Methods We retrospectively reviewed 93 consecutive adults who underwent volar plate open reduction and internal fixation for DRF from January 2020 to September 2023. Patients were grouped by intraoperative tourniquet use (Group I, n = 54) versus no tourniquet (Group II, n = 39). Outcomes included operative time, perioperative hemoglobin (Hgb) change, hospital stay, pain on postoperative day 1 (VAS), 1-year QuickDASH, standardized opioid consumption in morphine milligram equivalents (MME), and radiographic parameters (radial height, radial inclination, volar tilt). Multivariable linear regression adjusted for age, sex, BMI, and anesthesia type. Results All no-tourniquet cases were completed without conversion. Operative time and 1-year QuickDASH were similar between groups. Hgb drop was greater in the tourniquet group (mean 1.27 ± 0.92 vs 1.03 ± 0.38 g/dL, p = 0.03). The no-tourniquet group showed lower opioid use (mean 20.3 ± 15.5 vs 38.7 ± 6.2 mg MME, p < 0.05) and a shorter hospital stay (mean 11.1 ± 5.4 vs 15.8 ± 10.7 days, p < 0.05). VAS tended to be lower without tourniquet (4.9 ± 0.7 vs 5.1 ± 0.8, p = 0.11). Radiographic restoration (volar tilt, radial height, radial inclination) was comparable. Minor skin abrasions occurred only at tourniquet sites (n = 3), resolving conservatively. In adjusted analyses, tourniquet use was not an independent predictor of MME, Hgb change, or hospital stay (all p > 0.05). Conclusions No-tourniquet DRF fixation is feasible and associated with less opioid consumption and shorter hospitalization without compromising reduction quality or functional recovery. These data support a pragmatic tourniquet-free workflow for upper-extremity trauma surgery.