Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Orthopaedic Surgery and Research
Published in: Journal of Orthopaedic Surgery and Research 1/2018

Open Access 01-12-2018 | Research article

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

Authors: Ying-Cheng Huang, Chien-Jen Hsu, Jenn-Huei Renn, Kai-Cheng Lin, Shan-Wei Yang, Yih-Wen Tarng, Wei-Ning Chang, Chun-Yu Chen

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2018

Login to get access

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.
Literature
1.
Lalonde D, Martin A. Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia. J Am Acad Orthop Surg. 2013;21(8):443–7.CrossRefPubMed
2.
Lalonde D, Eaton C, Amadio PC, et al. Wide-awake hand and wrist surgery: a new horizon in outpatient surgery. Instr Course Lect. 2015;64:249–59.PubMed
3.
Liporace FA, Adams MR, Capo JT, et al. Distal radius fractures. J Orthop Trauma. 2009;23(10):739–48.CrossRefPubMed
4.
Diaz-Garcia RJ, Oda T, Shauver MJ, et al. A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg [Am]. 2011;36(5):824–35.e2.CrossRef
5.
Chung KC, Watt AJ, Kotsis SV, et al. Treatment of unstable distal radial fractures with the volar locking plating system. J Bone Joint Surg Am. 2006;88(12):2687–94.CrossRefPubMed
6.
Jupiter JP, Marent-Huber M, LCP Study Group, et al. Operative management of distal radial fractures with 2.4-millimeter locking plates. A multicenter prospective case series. J Bone Joint Surg Am. 2009;91(1):55–65.CrossRefPubMed
7.
Gottlieb M, Cosby K. Ultrasound-guided hematoma block for distal radial and ulnar fractures. J Emerg Med. 2015;48(3):310–2.CrossRefPubMed
8.
Tageldin M, Alrashid M, Khoriati A, et al. Periosteal nerve blocks for distal radius and ulna fracture manipulation—the technique and early results. J Orthop Surg Res. 2015;10:134.CrossRefPubMedPubMedCentral
9.
Ketonis C, Ilyas A, Liss F. Pain management strategies in hand surgery. Orthop Clin North Am. 2015;46(3):399–408.CrossRefPubMed
10.
Ceran C, Aksam B, Aksam E, et al. Selective nerve block combined with tumescent anesthesia. J Hand Surg [Am]. 2015;40(12):2339–44.CrossRef
11.
Protopsaltis T, Ruch D. Volar approach to distal radius fractures. J Hand Surg [Am]. 2008;33(6):958–5.CrossRef
12.
Hudak PL, Amadio PC, Bombardier C, et al. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder, and head). Am J Ind Med. 1996;29(6):602–8.CrossRefPubMed
13.
Hutchinson DT, McClinton MA. Upper extremity tourniquet tolerance. J Hand Surg [Am]. 1993;18(2):206–10.CrossRef
14.
Maury A, Roy W. A prospective, randomized, controlledtrial of forearm versus upper arm tourniquet tolerance. J Hand Surg (Br). 2002;27(4):359–60.CrossRef
15.
16.
17.
18.
Nakanishi Y, Omokawa S, Kobata Y, et al. Ultrasound-guided selective sensory nerve block for wide-awake forearm tendon reconstruction. Plast Reconstr Surg Glob Open. 2015;3(5):e392.CrossRefPubMedPubMedCentral
19.
Lalonde D. Wide-awake extensor indicis proprius to extensor pollicis longus tendon transfer. J Hand Surg [Am]. 2014;39(11):2297–9.CrossRef
20.
Gunasagaran J, Sean ES, Shivdas S, et al. Perceived comfort during minor hand surgeries with wide awake local anaethesia no tourniquet (WALANT) versus local anaethesia (LA)/tourniquet. J Orthop Surg (Hong Kong). 2017;25(3):1–4.CrossRef
21.
Xing S, Tang J. Surgical treatment, hardware removal, and the wide-awake approach for metacarpal fractures. Clin Plast Surg. 2014;41(3):463–80.CrossRefPubMed
22.
Mckee D, Lalonde D, Thoma A, et al. Achieving the optimal epinephrine effect in wide awake hand surgery using local anesthesia without a tourniquet. Hand (N Y). 2015;10(4):613–5.CrossRef
23.
McKee D, Lalonde D, Thoma A, et al. Optimal time delay between epinephrine injection and incision to minimize bleeding. Plast Reconstr Surg. 2013;131(4):811–4.CrossRefPubMed
24.
Mann T, Hammert W. Epinephrine and hand surgery. J Hand Surg [Am]. 2012;37(6):1254–6.CrossRef
25.
Lalonde D, Bell M, Benoit P, et al. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg [Am]. 2005;30(5):1061–7.CrossRef
26.
Thomson C, Lalonde D, Denkler K, et al. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg. 2007;119(1):260–6.CrossRefPubMed
27.
Nodwell T, Lalonde DH. How long does it take phentolamine to reverse adrenaline-induced vasoconstriction in the finger and hand? A prospective randomized blinded study: the Dalhousie Project experimental phase. Can J Plast Surg. 2003;11(4):187.CrossRefPubMedPubMedCentral
28.
Cunnington C, McDonald J, Singh R. Epinephrine-induced myocardial infarction in severe anaphylaxis: is nonselective β-blockade a contributory factor? Am J Emerg Med. 2013;31(4):759.e1–2.CrossRef
29.
Ruxasagulwong S, Kraisarin J, Sananpanich K. Wide awake technique versus local anesthesia with tourniquet application for minor orthopedic hand surgery: a prospective clinical trial. J Med Assoc Thail. 2015;98(1):106–10.
30.
LeBlanc MR, Lalonde DH, Thoma A, et al. Is main operating room sterility really necessary in carpal tunnel surgery? A multicenter prospective study of minor procedure room field sterility surgery. Hand. 2011;6(1):60–3.CrossRefPubMed
31.
Whiting P, Rice C, Avilucea F, et al. Patients at increased risk of major adverse events following operative treatment of distal radius fractures: inpatient versus outpatient. J Wrist Surg. 2017;6(3):220–6.CrossRefPubMedPubMedCentral
32.
Rhee P, Fischer M, Rhee L, McMillan H, Johnson A. Cost savings and patient experiences of a clinic-based, wide-awake hand surgery program at a military medical center: a critical analysis of the first 100 procedures. J Hand Surg [Am]. 2017;42(3):e139–47.CrossRef
33.
Lalonde D. Conceptual origins, current practice, and views of wide awake hand surgery. J Hand Surg Eur Vol. 2017;42(9):886–95.CrossRefPubMed
34.
Metadata
Title
WALANT for distal radius fracture: open reduction with plating fixation via wide-awake local anesthesia with no tourniquet
Authors
Ying-Cheng Huang
Chien-Jen Hsu
Jenn-Huei Renn
Kai-Cheng Lin
Shan-Wei Yang
Yih-Wen Tarng
Wei-Ning Chang
Chun-Yu Chen
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2018
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-018-0903-1

Other articles of this Issue 1/2018

Journal of Orthopaedic Surgery and Research 1/2018 Go to the issue

Research article

A novel revision surgery for treatment of cervical ossification of the posterior longitudinal ligament after initial posterior surgery: preliminary clinical investigation of anterior controllable antidisplacement and fusion

Research article

Incidence and predictors of surgical site infection after ORIF in calcaneus fractures, a retrospective cohort study

Research article

Intraoperative assessment of reduction and implant placement in acetabular fractures—limitations of 3D-imaging compared to computed tomography

Research article

Single coracoclavicular suture fixation with Mersilene tape versus hook plate in the treatment of acute type V acromioclavicular dislocation: a retrospective analysis

Research article

Serum levels of PIICP, PIIANP, and PIIBNP are decreased in patients with an endemic osteochondropathy, Kashin-Beck disease

Research article

Analysis of C5 palsy in cervical myelopathy with massive anterior compression following laminoplasty