The effect of using torniquets on fracture healing disorders: A study in wistar strain rats (Rattus norvegicus)

Background: Fracture is a discontinuity of bone tissue, growth plates and/or cartilage which generally caused by trauma. Fracture healing is influenced by many things, including patient condition, age, comorbidity, lifestyle, medication and management. The use of tourniquets in medical cases reached 20.000 cases per day around the world. In Norway between 2005 and 2006, the use of tourniquets on orthopedic surgery reached 63.484 cases. The goal of using a tourniquet is to obtain a blood-free operation field to achieve maximum operating results. However, deflation of tourniquets can lead to reperfusion mechanisms that cause injuries resulting from the production of Reactive Oxygen Species (ROS). This study aims to measure the level of malondialdehyde (MDA) and the osteoblast count after tourniquet application in murine mode. Methods: Thirty-two male Wistar strain rats were divided into two groups and tibial fracture with consequence casting was performed. The rats were divided into two groups, one control group (n = 16) and one treatment group (n = 16). Both groups' rats’ right tibia was fractured and immobilized with a long-leg cast. The tourniquet (4.5 oz orthodontic rubber) was applied to the treatment group for two hours. The evaluation of the osteoblast count and the malondialdehyde (MDA) level was done on day 14. The quantitative osteoblast count was done under light microscopy within 10 high power fields in 4000x magnification. The MDA level was measured by using Thiobarbituric Acid Reactive Substances (TBARS) assay. Data analysis was done by using independent t-test. Results: There was elevated MDA levels (0,126 in group 1 compared to 8763 in group 2) with p < 0,001 and a significant decrease in the number of osteoblasts seen histologically in group 2 (9,00) compared to group 1 (14,438) with p < 0,05. Conclusions: The use of tourniquets can increase MDA levels due to oxidative stress arising from ischemic-reperfusion injury, as well as decreasing the number of osteoblasts.