Tourniquets are widely accepted as "safe" for up to two hours of continued intraoperative use, despite risks and scant literature supporting this duration. Clinical outcomes of tourniquet use have been studied, but studies were small and did not use robust physical exam measures or patient reported outcomes. Our purpose is to determine the relationship between intraoperative tourniquet use for ankle fracture surgery and postoperative pain, patient reported outcomes, functional measures and intramuscular pH.