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 score, Mayo 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.