WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniqu
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RESEARCH ARTICLE
Open Access
WALANT for distal radius fracture: open reduction with plating fixation via wideawake local anesthesia with no tourniquet Ying-Cheng Huang1,2, Chien-Jen Hsu1, Jenn-Huei Renn1, Kai-Cheng Lin1, Shan-Wei Yang1, Yih-Wen Tarng1, Wei-Ning Chang1 and Chun-Yu Chen1,2,3*
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. Keywords: Distal radius fracture, WALANT, Wide awake, No tourniquet
* Correspondence: [email protected] 1 Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City 81362, Taiwan, Republic of China 2 Department of Orthopedic Surgery, National Defense Medical Center, Taipei, Taiwan, Republic of China Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under
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