Wide-Awake Surgical Management of Hand Fractures: Technical Pearls and Advanced Rehabilitation

Hyatt, Brad T.; Rhee, Peter C.

doi:10.1097/prs.0000000000005379

Cited by 20 publications

(7 citation statements)

References 31 publications

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“…Future areas of research and innovation include performing fixation using lidocaine and epinephrine (in place of general anesthesia) with no tourniquet in "wide-awake" operations. [68][69][70] Some authors claim better intraoperative assessment of fracture stability that facilitates quicker recovery and range-of-motion exercises, minimizing finger stiffness. Research has also been conducted on the use of absorbable plates for displaced finger fractures; however, the quality of evidence is lacking to recommend routine use.…”

Section: Discussionmentioning

confidence: 99%

An Evidence-Based Guide for Managing Phalangeal Fractures

Kumar

Chung

2021

Plastic &Amp; Reconstructive Surgery

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halangeal fractures make up a quarter of hand and forearm fractures and are the second most common fracture of the upper extremity after distal radius and ulna fractures. 1,2 The highest incidence (21 percent) of phalangeal fractures occur in children aged 5 to 14 years and, overall, they are the most prevalent type of fracture in male patients. The most common mechanism of injury among pediatric patients is a crush injury during sport, whereas among adult patients, work-related injuries are the most common. 3 The distal phalanx is the most commonly fractured phalanx.Fractures of the phalanges are described according to the anatomical location (i.e., proximal, middle, or distal), fracture pattern (i.e., transverse, oblique, spiral, comminuted, or impacted), degree of displacement (i.e., none, minimal, or displaced), and articular involvement (i.e., none, unicondylar, or bicondylar). The initial workup of such fractures should involve three-view radiographs of the hand and dedicated radiographic views of the injured finger if needed. The decision for additional imaging modalities such as magnetic resonance imaging or ultrasound (for soft-tissue injury) or computed tomographic scan (for occult bony fractures) should be made based on clinical suspicion for concomitant injuries.These fracture characteristics are considered with associated injuries (e.g., open wounds, nail bed injuries, other fracture sites) and amount of soft-tissue loss to determine fracture stability and guide treatment strategies. Treatment options for phalangeal fractures encompass splinting or buddy taping with or without closed reduction, and operative treatment by percutaneous and open techniques. Operative indications for phalangeal fractures are listed in Table 1.This article will use a case-based approach to describe the steps involved in evaluating a phalangeal fracture and use an evidence-based approach to develop a treatment strategy. The principles in workup and treatment for each fractured digit are applicable to other digits sustaining similar fracture patterns. DISTAL PHALANX TUFT FRACTURE Representative CaseCase 1 An 11-year-old presents with a thumb crush injury involving a door. There is a subungual hematoma of

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Section: Discussionmentioning

confidence: 99%

An Evidence-Based Guide for Managing Phalangeal Fractures

Kumar

Chung

2021

Plastic &Amp; Reconstructive Surgery

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“…Surgery was performed by 2 experienced hand surgeons of our department. In order to get a better judgment, we use the wide-wake technique for anesthesia that is the fluoroscopy and activity of DIP (or PIP) can be judged during the operation [13] …”

Section: Methodsmentioning

confidence: 99%

Percutaneous pinning with interphalangeal joint locked in phalanx fractures

Liu¹,

Sun²,

Wang³

et al. 2021

Medicine

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Background:The purpose of the study was to compare the operation time, the fracture healed time, the postoperative function recovery between the techniques that temporary locking of the interphalangeal joint and traditional manual reduction in the treatment of percutaneous pinning of the phalanx fractures.Methods:Patients with phalanx fractures from January 2015 to January 2018 who were admitted to our hospital were retrospectively reviewed. Patients received surgery with traditional manual or temporary locking of the interphalangeal joint reduction. The information of patients, including age, gender, the length of the operation, the fracture healed time, the postoperative function recovery, complication, and length of postoperative hospital stay, was collected. All of the information were evaluated and compared between the 2 groups. All of the surgery were performed by 2 experienced hand surgeons of our department. The patients in the 2 groups were followed up for an average of 6 months after surgery.Results:All patients completed the operation and were followed up completely. There was no significant difference in baseline data between the 2 groups (P > .05). The observation group who received surgery with the interphalangeal joint locked technique had significantly shorter in operative time than the control group (P < .05). And postoperative complications in the observation group were significantly less than those in the control group (P < .05). However, the postoperative functional recovery in both groups was no significant difference between the 2 groups (P > .05). And there were no significant differences in the fracture healed time and length of postoperative hospital stay between the 2 groups (P > .05).Conclusion:Both surgical techniques can enable patients to achieve good function, but the technique of interphalangeal joint locked is effective in the treatment of the phalanx fractures, as it is characterized by short operations and a quick recovery. However, this technique is only suitable for extra-articular phalanx fractures that the AO/ASIF classification of type A2.3 and less than 2 weeks, not for other phalanx fractures.

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“…3,5 Instead, the danger of end-artery organ necrosis that is stigmatized by physicians was previously derived from the preceding local anesthesia, which was the expired procaine, instead of epinephrine. 3,6 In addition, epinephrine has been widely practiced in surgeries for vascular malformation, 7 fractures, 8 hand intrinsic flaps, 9 burn contractures, 10 digital replantation, 11 etc.…”

Section: Historical Perspectivementioning

confidence: 99%

No Tourniquet Technique of Surgery for Macrodactyly

Prasetyono

Santoso

2021

Techniques in Foot &Amp; Ankle Surgery

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The tourniquet technique in limb surgery has traditionally been performed to produce bloodless operative fields. Nevertheless, there are limitations derived from the tourniquet itself; either the complications that may occur because of the ischemic effects, or the constraint of time because of the ischemic time. As no surgeon expects dreadful adverse events in their practices, an alternative technique may fill up the demand. The implementation of epinephrine, which was previously believed to be dangerous, has been performed in end-artery organs such as toes and fingers. In this article, the authors apply the tumescent technique with the use of 1:1,000,000 epinephrine or shortly termed as one-per-mil solution, without using the pneumatic tourniquet. The technique presents relatively clear operative fields, yet safe. Although the risk of bleeding is higher because of the enlarged vascular caliber and all structures around the affected digits, the technique facilitates clear visualization of important structures. In addition, the long action of the one-per-mil tumescent solution notably provides a much longer surgery duration, which facilitates complex surgery for macrodactyly.Level of Evidence: Treatment level of evidence IV-case series. See Instructions for Authors for a complete description of levels of evidence.

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Wide-Awake Surgical Management of Hand Fractures: Technical Pearls and Advanced Rehabilitation

Cited by 20 publications

References 31 publications

An Evidence-Based Guide for Managing Phalangeal Fractures

An Evidence-Based Guide for Managing Phalangeal Fractures

Percutaneous pinning with interphalangeal joint locked in phalanx fractures

No Tourniquet Technique of Surgery for Macrodactyly

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