# Knowledge, training, and practice patterns in pneumatic tourniquet use among orthopedic physicians: a national cross-sectional survey

## TL;DR

This study finds that many orthopedic surgeons in Türkiye lack proper training and knowledge about safely using pneumatic tourniquets, leading to potential complications.

## Contribution

The study reveals significant gaps in structured training and theoretical knowledge about tourniquet use among orthopedic physicians in Türkiye.

## Key findings

- Only 35.7% of participants received both theoretical and practical tourniquet training.
- Most knowledge came from residency experience rather than formal education.
- Common complications included skin injuries, muscle weakness, and nerve damage.

## Abstract

Pneumatic tourniquets are widely used in orthopedic surgery to create a bloodless operative field; however, improper use may result in skin, muscle, and nerve injuries, as well as rare but severe systemic complications. Despite their frequent use, the extent of theoretical knowledge and structured training among orthopedic surgeons remains unclear. This study aimed to evaluate knowledge levels, clinical practices, complication awareness, and training needs regarding pneumatic tourniquet use among orthopedic specialists and residents in Türkiye.

This cross-sectional survey was conducted between April 1 and May 1, 2025, using an online questionnaire based on AORN 2007 pneumatic tourniquet safety guidelines. Orthopedic specialists and residents across various hospital types were invited to participate voluntarily. The questionnaire assessed demographic characteristics, training status, knowledge of safe tourniquet practices, and complication experiences. Data were analyzed using SPSS v25.0, with significance set at p < 0.05.

A total of 300 physicians participated; 45.3% were senior specialists. Although tourniquet use was frequent (48.7% in almost every surgery), only 35.7% received both theoretical and practical training. Notably, 248 participants reported that their knowledge was gained primarily through residency experience rather than structured education. Skin injuries (41.3%), muscle weakness (37.3%), and nerve injury (30.3%) were the most common complications. Knowledge gaps were prominent, particularly regarding IVRA-related systemic toxicity (24% correct), prolonged tourniquet use complications (48.3% correct), and physiological changes after deflation (68.7% correct). Experience and training level showed limited impact on overall knowledge, except for the question regarding prolonged tourniquet duration (p = 0.01).

Despite widespread use, substantial deficiencies exist in theoretical knowledge and structured training on pneumatic tourniquet application. Reliance on experiential learning during residency appears insufficient and contributes to inconsistent practices and increased complication risk. Standardized, evidence-based training programs are urgently needed to improve safety and reduce variability in clinical practice.

The online version contains supplementary material available at 10.1007/s00402-025-06176-1.