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WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet
- Source :
- Journal of Orthopaedic Surgery and Research, Journal of Orthopaedic Surgery and Research, Vol 13, Iss 1, Pp 1-11 (2018)
- Publication Year :
- 2018
-
Abstract
- Background The 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. Methods From 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. Results One 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. Conclusions WALANT 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 material The online version of this article (10.1186/s13018-018-0903-1) contains supplementary material, which is available to authorized users.
- Subjects :
- Adult
No tourniquet
medicine.medical_specialty
lcsh:Diseases of the musculoskeletal system
Consciousness
medicine.medical_treatment
Sedation
WALANT
030230 surgery
Wrist
03 medical and health sciences
Fracture Fixation, Internal
Young Adult
0302 clinical medicine
lcsh:Orthopedic surgery
medicine
Wide awake
Internal fixation
Humans
Orthopedics and Sports Medicine
Local anesthesia
Range of Motion, Articular
Aged
Retrospective Studies
Aged, 80 and over
030222 orthopedics
Tourniquet
business.industry
Perioperative
Middle Aged
Tourniquets
Surgery
lcsh:RD701-811
medicine.anatomical_structure
Treatment Outcome
Orthopedic surgery
lcsh:RC925-935
medicine.symptom
Range of motion
business
Radius Fractures
Bone Plates
Anesthesia, Local
Research Article
Distal radius fracture
Subjects
Details
- ISSN :
- 1749799X
- Volume :
- 13
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Journal of orthopaedic surgery and research
- Accession number :
- edsair.doi.dedup.....f88c431c6f4d5182edfc8df7a89503d8