Open reduction and internal fixation of intra-articular distal radius fractures under wide-awake local anesthesia with no tourniquet

Abstract

ObjectiveThe use of wide-awake local anesthesia with no tourniquet (WALANT) is becoming an excellent alternative for elective hand surgeries and hand surgeries involving minor trauma. Although the use of WALANT for some soft tissue surgeries has become the state of the art, data regarding bony procedures, such as fracture management, under WALANT are limited. This study was performed to assess the WALANT technique for open reduction and internal fixation of distal radius fractures.MethodsFive patients with displaced distal radius fractures were enrolled in the study. WALANT was carried out about 30 minutes prior to the first incision. Surgery was performed in the normal fashion, and the fractures were fixed using anatomic locking plates. After surgery, the patients were admitted overnight for observation and pain assessment, and they were discharged within 24 hours postoperatively. Intraoperative and postoperative complications were recorded. Follow-up was performed in our outpatient clinic. No abnormalities were recorded.ResultsAll patients underwent a successful painless surgery. No extra bleeding or other complications were recorded.ConclusionThe WALANT technique offers a simple and safe alternative to traditional anesthetic techniques for open reduction and plating of distal radius fractures.

Distal radius fracture volar locking plate osteosynthesis using wide-awake local anaesthesia

“…The use of WALANT in plating distal radius fractures has been reported with good results (Ahmad et al., 2018; Huang et al., 2018; Orbach et al., 2018). Huang et al.…”

“…Its use in distal radius fractures would make it possible to perform intraoperative motor testing, to evaluate the stability of the fixation under active muscle contractions, and to assess the potential impingement of the flexor pollicis longus (FPL) tendon on the plate. Feasibility of this technique in distal radius fractures has been briefly evaluated (Ahmad et al., 2018; Huang et al., 2018; Orbach et al., 2018).…”

Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique

“…The WALANT technique was only last year reported as an anaesthesia option for surgery of distal radius fractures. 12 - 14 The technique and one case were first described by Ahmad et al, 12 and Orbach et al 13 subsequently described successfully operating on five cases. Orbach et al 13 concluded that the WALANT technique offers a simple and safe alternative to traditional anaesthetic techniques for surgery on distal radius fractures.…”

Wide Awake Local Anesthesia no Tourniquet (WALANT)

“…Jedoch werden zunehmend auch ausgedehntere elektive Eingriffe in WALANT-Technik beschrieben, wie z. B.: ▪ Arthroskopien [25], ▪ Plattenosteosynthesen bei Radiusfrakturen [17], ▪ Implantationen trapeziometakarpaler Prothesen bei Rhizarthrosen [26], ▪ Resektionsarthroplastiken. Hinsichtlich des klinischen Outcomes konnte bisher keine Überlegenheit der WALANT-Technik gegenüber herkömmlicher Anästhesie für die meisten Indikationen bewiesen werden [3].…”