Tourniquet use in orthopaedic surgery

The application of a tourniquet is a routine adjunct to current orthopaedic surgical practice. It is commonplace for both elective and trauma surgery. This review article seeks to explore the issues surrounding tourniquet and current best practice. The technological evolution in the application of a tourniquet to produce a bloodless field has remained relatively unchanged compared to other more complex advances in modern surgical practice. Despite a tourniquet's relative simplicity, considerable controversy surrounds its exact application; the surgeon constantly seeks a balance between the inevitable morbidity associated with its use versus the advantages conferred by such a device. To trace the history of the tourniquet is of interest and provides a backdrop to understanding the current controversies associated with its use as well as predicting where the next possible evolutions might take place. The tourniquet is often taken for granted, but there is a considerable body of work surrounding its use and safe application. Correct application, training of staff and appropriate use on an individual basis are essential to maximize safety and benefit.