Non-Tourniquet Strategy with High-Position Low-Perfusion in Distal Humeral Fracture Surgery: Reduces Swelling Without Increasing Blood Loss

Introduction: To evaluate the feasibility of non-tourniquet strategy combined with “High-position Low-Perfusion” positioning in distal humeral fractures ORIF (DHF-ORIF), and to investigate its effects on perioperative blood loss, postoperative rehabilitation, and functional outcomes. Methods Prospective inclusion of patients aged 18–45 with distal humeral fractures, randomly divided into an experimental group without tourniquets (Group A) and a control group with traditional tourniquets (Group B). The Group A adopted a lateral position with high and low perfusion of the affected limb, and received intravenous injection of TXA (15 mg/kg) combined with continuous flushing with 4 ℃ physiological saline during the operation; The control group received routine use of tourniquets. Primary Outcomes: perioperative blood loss, elbow ROM and degree of limb swelling. Secondary Outcomes: Postoperative VAS scorMayo elbow joint score and DASH score, and incidence of complications. Results No significant difference was observed in total perioperative blood loss between the Group A and the Group B (240.78 mL vs. 228.53 mL, p > 0.05). However, the Group A demonstrated significantly reduced postoperative drainage volume and hidden blood loss (p < 0.05). The Group A exhibited significantly superior outcomes in terms of VAS scores and limb swelling, compared with the control group. Additionally, elbow ROM improvement was more significant at 2–4 weeks and 2 months postoperatively in the Group A. At the 6-month follow-up, the Group A showed significantly higher Mayo scores (89.78 ± 11.89 vs. 83.55 ± 16.29) compared with the control group (p = 0.036). Furthermore, the Group A had significantly lower wound complication rates and shorter hospital stays (7.25 ± 1.53 vs. 8.11 ± 2.34 days, p = 0.037). Conclusion The non-tourniquet strategy combined with “High-position Low-Perfusion” positioning is safe and effective for DHF-ORIF. It effectively controls postoperative swelling and pain without increasing perioperative blood loss, leading to improved clinical outcomes and quality of life.