WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet

Abstract

BackgroundThe wide-awake local anesthesia no tourniquet (WALANT) technique is applied during various hand surgeries. We investigated the perioperative variables and clinical outcomes of open reduction and internal fixation (ORIF) for distal radius fractures under WALANT.MethodsFrom January 2015 to January 2017, 60 patients with distal radius fractures were treated, and 24 patients (40% of all) were treated with either a volar or a dorsal plate via WALANT procedure. Of these 24 patients, 21 radius fractures were fixed with a volar plate, and the other 3 were fixed with a dorsal plate. Radiographs; range of motions; visual analog scale (VAS); quick disabilities of the arm, shoulder, and hand (Quick DASH) questionnaire; and time to union were evaluated.ResultsOne of the 24 patients could not tolerate the WALANT procedure and was reported as a failed attempt at WALANT. In the cohort, 23 patients successfully received distal radius ORIF under WALANT procedure. The average age is 60.9 (range, 20–88) years. The average operation time was 64.3 (range, 45–85) minutes, the average blood loss was 18.9 (range, 5–30) ml, and the average of duration of hospitalization is 1.8 (range, 1–6) days. The average postoperative day one VAS was 1.6 (range, 1–3). The average time of union was 20.7 (range, 15–32) weeks. The mean follow-up period was 15.1 (range, 12–24) months. Functional 1-year postoperative outcomes revealed an average Quick DASH score of 7.60 (range, 4.5–13.6) and an average wrist flexion and extension of 69.6° (range, 55–80°) and 57.4° (range, 45–70°). There was no wound infection, neurovascular injury, or other major complication noted.ConclusionsWALANT for distal radius fracture ORIF is a method to control blood loss by the effects of local anesthesia mixed with hemostatic agents. Without a tourniquet, the procedure prevents discomfort caused by tourniquet pain. Without sedation, patients could perform the active range of motion of the injured wrist to check if there is impingement of implants. It eliminates the need of numerous preoperative examinations, postoperative anesthesia recovery room care, and side effects of the sedation. However, patients who are not amenable to the awake procedure are contraindications.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0903-1) contains supplementary material, which is available to authorized users.

Evaluating Clinical Outcomes for Determining the Optimal Delay to Skin Incision under WALANT: A Prospective Series of 34 Patients from a Low-Resource Tertiary Setting

“…Moreover, we performed all procedures without the aid of surgical loupes, which could have promoted optimal tissue handling and dissection, and thus prevented iatrogenic soft tissue injury and wound complications. Although the low postoperative pain scores we found, in addition to those found by Huang et al in their study [ 1 ], they must lay support to the latter authors' findings of significantly lower mean postoperative pain score under WALANT, in their subsequent comparative study on 47 distal radius fractures treated by volar plating, under either WALANT or general anesthesia with arm tourniquet [ 7 ].…”

“…The neuroma was conservatively treated with 150 mg of oral pregabalin (LYRICA ® ; Pfizer, Inc., New York City, USA) daily for a week, which completely resolved the pain thereafter. Huang et al [ 1 ], in a retrospective analysis of 24 distal radius fractures treated by open reduction and plating under WALANT, documented no complications following a mean follow-up period of 15 months. In contrast to Huang et al's study, the complication rate (9%) we found in our series must be high.…”

“…Hand surgeries traditionally rely on tourniquet to minimize intraoperative bleeding. However, upper arm tourniquet may cause pain and discomfort among wide-awake patients without general anesthesia or brachial plexus block [ 1 , 2 ]. Minor procedures of the hand and wrist can be performed with local anesthesia without sedation on an outpatient basis.…”

“…Minor procedures of the hand and wrist can be performed with local anesthesia without sedation on an outpatient basis. Use of upper arm tourniquet, however, can limit the duration of procedure due to excessive pain caused on some patients [ 2 – 4 ].The wide-awake local anesthesia no tourniquet (WALANT) technique [ 5 ], in which lidocaine and epinephrine are injected for local anesthesia and vasoconstriction, respectively, has been increasingly used for hand surgeries [ 1 , 6 , 7 ].The WALANT technique enables the surgery to be performed with the patient fully awake and without upper arm tourniquet, which allows intraoperative assessment of function during the procedure [ 1 , 5 ].…”

Is Wide-Awake Local Anesthesia No Tourniquet Technique in Distal Radius Plating Surgery a Comfortable Procedure? A Prospective Case-Control Study

“…WALANT offers technical simplicity, and the whole procedure can be performed by a surgeon without the use of sedation. In recent few years, the WALANT technique has been employed for bony procedures, such as open reduction plating for distal radius fracture [4][5][6][7] , olecranon fracture 8 , and ankle fracture 9 . Because of no major complications, previous studies 6,8 have concluded that WALANT is a safe and simple option for patients with a high-grade anesthesia or sedation risk.…”