DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.041

Pages: 2597-2599

Pneumatic tourniquets are widely used in upper-limb surgery to provide a bloodless operative field, but nerve injury remains a rare and potentially disabling complication. We report a series of five patients who developed postoperative radial nerve palsy after upper-limb surgery performed with a pneumatic tourniquet between January 2020 and December 2022. The mean age was 39 years and three patients were male. Surgical indications included two forearm malunions, one terrible triad of the elbow, one wrist malunion, and one recent forearm fracture. The tourniquet was inflated to 250 mmHg in all cases. Operative duration was less than 90 minutes in three patients, 100 minutes in one, and 105 minutes in one. All patients developed a high radial motor deficit; sensory impairment was present in three cases. Electromyography performed one month postoperatively showed neurapraxia with conduction disturbance in three patients and a more severe nerve injury pattern in two. All patients received vitamin supplementation and functional rehabilitation. Three patients recovered within four months and the remaining two by six months; wrist extension recovered before finger extension in every case. These observations highlight the need for individualized tourniquet pressure, appropriate cuff selection and positioning, minimization of inflation time, and early neurological assessment when postoperative weakness occurs.