Fixation of Distal Radius Fractures Under Wide-Awake Local Anesthesia: A Systematic Review

Abstract

Background: The purpose of this systematic review was to analyze the available literature on fixation of distal radius fractures (DRFs) under wide-awake local anesthesia no-tourniquet (WALANT), and to examine postoperative pain scores and functional outcomes, operative data including operative time and blood loss, and the frequency of adverse events. Methods: Embase, MEDLINE, Web of Science, and SCOPUS were searched from inception until May 2022 for relevant studies. Studies were screened in duplicate, and data on pain scores, functional outcomes, and adverse events were recorded. Due to methodological and statistical heterogeneity, the results are presented in a descriptive fashion. Results: Ten studies were included comprising 456 patients with closed, unilateral DRFs, of whom 226 underwent fixation under WALANT. These patients had a mean age of 52.8 ± 8.3 years, were 48% female, and had a mean follow-up time of 11.6 months (range: 6-24). Operative time for WALANT patients averaged 60.4 ± 6.5 minutes, with mean postoperative pain scores of 1.4 ± 0.6 on a 10-point scale. Studies that compared WALANT to general anesthesia found shorter hospital stays with most WALANT patients being sent home the same day, decreased postoperative pain scores, and decreased costs to the healthcare system. No adverse events were reported for WALANT patients. Conclusions: A growing body of literature reports that for closed, unilateral DRF, surgical fixation under WALANT is a safe and effective option. It allows patients to have surgery sooner, with improved pain scores and good functional outcomes, with a very low incidence of adverse events.

WALANT surgery of the hand: state of the art

“…Every year, new reports that push boundaries are published. There are recent reports of wrist surgery, radius, and ulna fracture plating, elbow surgery, clavicle plating, and major limb amputations (71,72,73,74,75,76,77,78,79,80). Although the cost benefits of this approach in these cases are evident, the absolute indications for these procedures are not yet completely clear and are still limited to preferences or circumstances outruling other options (66,81,82,83).…”

Adoption of the Wide-Awake Local Anesthesia No Tourniquet Technique in Hand Surgery

“…Because the main operating room and anesthesia support are no longer necessary, access to hand surgery has improved as WALANT technique usage has become more widespread, particularly in developing countries 43,44 . For instance, in a systematic review of patients with closed distal radius fractures, Gouveia et al concluded that the wide-awake local anesthesia method is a safe and effective option permitting patients to have surgery sooner, rather than waiting for availability of anesthesia services 45 . Thus, the WALANT alternative is important in locations where general anesthesia resources are limited 46 .…”

A systematic review of tourniquet use in paediatric orthopaedic surgery: can we extrapolate from adult guidelines?

“…It is estimated that avoiding their use in knee arthroplasty could prevent nearly 2000 serious adverse events per year in the UK alone ( 29 ). Similarly, wide-awake local anaesthesia no tourniquet (WALANT) surgery for adult upper limb orthopaedic operations has been increasing in popularity and has shown good clinical results with reduced risk and cost ( 30 , 31 , 32 , 33 ).…”