Plating Distal Radius Fractures Using Wide-Awake Local Anesthesia No Tourniquet (WALANT) Versus General Anesthesia: A Cohort Study

Objective The use of wide-awake local anesthesia with no tourniquet (WALANT) is becoming an excellent alternative for elective hand surgeries and hand surgeries involving minor trauma. Although the use of WALANT for some soft tissue surgeries has become the state of the art, data regarding bony procedures, such as fracture management, under WALANT are limited. This study was performed to assess the WALANT technique for open reduction and internal fixation of distal radius fractures. Methods Five patients with displaced distal radius fractures were enrolled in the study. WALANT was carried out about 30 minutes prior to the first incision. Surgery was performed in the normal fashion, and the fractures were fixed using anatomic locking plates. After surgery, the patients were admitted overnight for observation and pain assessment, and they were discharged within 24 hours postoperatively. Intraoperative and postoperative complications were recorded. Follow-up was performed in our outpatient clinic. No abnormalities were recorded. Results All patients underwent a successful painless surgery. No extra bleeding or other complications were recorded. Conclusion The WALANT technique offers a simple and safe alternative to traditional anesthetic techniques for open reduction and plating of distal radius fractures.

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Comparison of Wide-Awake Local Anesthesia No Tourniquet With General Anesthesia With Tourniquet for Volar Plating of Distal Radius Fracture

Orthopedics ◽

10.3928/01477447-20181206-01 ◽

2018 ◽

Vol 42 (1) ◽

pp. e93-e98 ◽

Cited By ~ 10

Author(s):

Ying-Cheng Huang ◽

Chun-Yu Chen ◽

Kai-Cheng Lin ◽

Shang-Wei Yang ◽

Yih-Wen Tarng ◽

...

Keyword(s):

General Anesthesia ◽

Distal Radius Fracture ◽

Local Anesthesia ◽

Distal Radius ◽

Radius Fracture ◽

Volar Plating ◽

Wide Awake ◽

No Tourniquet

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Fixation of distal radius fractures using wide-awake local anaesthesia with no tourniquet (WALANT) technique

Bone and Joint Research ◽

10.1302/2046-3758.97.bjr-2019-0315.r1 ◽

2020 ◽

Vol 9 (7) ◽

pp. 429-439

Author(s):

Muhammad Tahir ◽

Ejaz Ali Chaudhry ◽

Zain Zaffar ◽

Kashif Anwar ◽

Muhammad Ameer Hamza Mamoon ◽

...

Keyword(s):

Patient Satisfaction ◽

General Anaesthesia ◽

Clinical Outcomes ◽

Distal Radius ◽

Hospital Costs ◽

Cost Effective ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Wide Awake ◽

No Tourniquet

Aims We hypothesized that the wide-awake local anaesthesia with no tourniquet (WALANT) technique is cost-effective, easy to use, safe, and reproducible, with a low learning curve towards mastery, having a high patient satisfaction rate. Furthermore, WALANT would be a suitable alternative for the austere and developing nation environments where lack of funds and resources are a common issue. Methods This was a randomized control trial of 169 patients who required surgery for closed isolated distal radius fractures. The study was performed between March 2016 and April 2019 at a public sector level 1 trauma centre. General anaesthesia was used in 56 patients, Bier’s block in 58 patients, and WALANT in 55 patients. Data were collected on pre-, peri-, and postoperative parameters, clinical outcome, hospital costs, and patient satisfaction. One-way analysis of variance (ANOVA) was used with a p-value of 0.05 being significant. Results Operations with WALANT proceeded sooner, and patients recovered faster, resulting in mean fewer missed working days (7.8 (SD 1.67)) compared with general anaesthesia (20.1 (SD 7.37)) or Bier’s block (14.1 (SD 7.65)) (p < 0.001). The WALANT patients did not develop complications, while the other patients did (p < 0.04). Clinical outcomes did not differ, nor did surgeon qualification affect clinical outcomes. Mean hospital costs were lower for WALANT ($428.50 (SD 77.71)) than for general anaesthesia ($630.63 (SD 114.77)) or Bier’s block ($734.00 (SD 37.54)) (p < 0.001). Patient satisfaction was also higher (p < 0.001). Conclusion WALANT for distal radius fractures results in a faster recovery, is more cost-effective, has similar clinical outcomes, and has fewer complications than general anaesthesia or Bier's block. This makes WALANT an attractive technique in any setting, but especially in middle- and low-income countries. Cite this article: Bone Joint Res 2020;9(7):429–439.

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Distal radius fracture volar locking plate osteosynthesis using wide-awake local anaesthesia

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420916418 ◽

2020 ◽

Vol 45 (8) ◽

pp. 857-863

Author(s):

Ruben Dukan ◽

Elie Krief ◽

Remy Nizard

Keyword(s):

Distal Radius ◽

Local Anaesthesia ◽

Regional Anaesthesia ◽

Plate Osteosynthesis ◽

Clinical Results ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Level Of Evidence ◽

Wide Awake ◽

No Tourniquet

Surgical fixation of distal radius fractures under local anaesthesia with the patient wide awake allows an intraoperative testing of the fixation stability under active mobilization. We evaluated the feasibility and clinical results of this technique in 45 patients prospectively in two matched comparable groups: wide-awake local anaesthesia no tourniquet and loco-regional anaesthesia. We found that the pain scores during the anaesthetic administration and the surgical procedure were similar in two groups. Ranges of wrist motion and QuickDASH scores were improved significantly in the wide-awake local anaesthesia no tourniquet group at 6 weeks and 3 months and similar at 6 months compared with those receiving loco-regional anaesthesia. Patients in wide-awake local anaesthesia no tourniquet returned to work significantly earlier than the loco-regional anaesthesia group. We conclude that osteosynthesis of distal radius fractures can be safely performed under wide-awake local anaesthesia no tourniquet, leading to no increase in pain level and similar functional outcomes compared with those under loco-regional anaesthesia. Level of evidence: III

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The spanning plate as an internal fixator in complex distal radius fractures: a prospective cohort study

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01738-5 ◽

2021 ◽

Author(s):

Rémy Liechti ◽

Reto Babst ◽

Urs Hug ◽

Björn-Christian Link ◽

Bryan J. M. van de Wall ◽

...

Keyword(s):

Cohort Study ◽

Distal Radius ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Distal Radius Fractures ◽

Internal Fixator ◽

Radius Fractures

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Radiographic Outcomes and Complications of Delayed Fixation of Distal Radius Fractures

Hand ◽

10.1177/1558944720930301 ◽

2020 ◽

pp. 155894472093030

Author(s):

Stella J. Lee ◽

Derek S. Stenquist ◽

Jamie E. Collins ◽

Ariana N. Mora ◽

Brett A. Teplitz ◽

...

Keyword(s):

Cohort Study ◽

Surgical Treatment ◽

Distal Radius ◽

Distal Radius Fractures ◽

X Rays ◽

Matched Cohort ◽

Radius Fractures ◽

Radiographic Outcomes ◽

Radiographic Parameters ◽

Surgical Fixation

Background: Surgeons are sometimes presented with patients with distal radius fractures who present in a delayed fashion or lose reduction after several weeks of attempted closed management. There are limited studies on delayed surgical treatment of distal radius fractures to assist providers in decision-making. Methods: We conducted a matched cohort study to compare radiographic outcomes and complications for patients with a distal radius fracture treated with delayed (3-5 weeks) or early (0-2 weeks) surgical fixation. Patients ages 18+ who underwent open reduction and internal fixation of distal radius fractures by a volar approach at 2 Level I trauma centers between 2003 and 2015 were eligible. We measured radiographic outcomes and reviewed medical records to determine operative approach and complications. Results: There were 25 cases and 50 controls matched for age (18-87), sex, and AO fracture type. The delayed group had surgery at a mean of 24.8 days from injury and the early group at 5.6 days. There was no statistically significant difference between the delayed and early cohorts in radiographic parameters on injury x-rays, in improvement in radiographic parameters on first postoperative x-rays, or in maintenance of radiographic parameters at union. Conclusion: We did not find significant differences in radiographic outcomes or complication rates between patients with delayed versus early surgical treatment for distal radius fracture. Providers treating patients with late presentation or late displacement have the option of surgical fixation beyond the first few weeks after injury. Level of Evidence: III (Retrospective matched cohort study)

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A Cohort Study of One-Year Functional and Radiographic Outcomes following Intra-Articular Distal Radius Fractures

Hand ◽

10.1007/s11552-013-9586-6 ◽

2014 ◽

Vol 9 (2) ◽

pp. 237-243 ◽

Cited By ~ 7

Author(s):

Emily A. Lalone ◽

Vaishnav Rajgopal ◽

James Roth ◽

Ruby Grewal ◽

Joy C. MacDermid

Keyword(s):

Cohort Study ◽

Distal Radius ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Radiographic Outcomes ◽

One Year

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A novel retractor-assisted closed reduction combined with percutaneous pinning fixation for the treatment of elderly distal radius fractures: a retrospective cohort study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02556-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Bin Zhao ◽

Wenqian Zhao ◽

Isaac Assan ◽

Zhenji Li ◽

Rongxiu Bi

Keyword(s):

Cohort Study ◽

Distal Radius ◽

Closed Reduction ◽

Retrospective Cohort ◽

The Elderly ◽

Distal Radius Fractures ◽

Percutaneous Pinning ◽

Radius Fractures ◽

Steinmann Pin

Abstract Background Percutaneous pinning fixation (PCP) has been used for the treatment of distal radius fractures for decades, especially in the elderly with fragile soft tissue. However, achieving and maintaining a sound anatomic reduction before PCP is difficult if we use the manipulative reduction method alone. Our study innovatively applied the Steinmann pin retractor for closed reduction combined with PCP, to provide a new protocol for the treatment of distal radius fractures. Methods From March 2017 to July 2018, 49 patients out of 57 that met the inclusion criteria but not the exclusion criteria were included in our retrospective cohort study. Sixteen patients were treated with Steinmann pin retractor-assisted closed reduction combined with PCP (S-PCP), and 19 patients were treated with the manipulative reduction combined with PCP (M-PCP), and 14 patients were treated with the manipulative reduction combined with cast splint (M-C). All these patients received a positive postoperative radiological and clinical evaluation. Results All the patients were followed up for a minimum of 2 years. The radiological parameters in each group improved significantly postoperative (posttreatment). In the S-PCP group, the values of radial height (postoperative, 13.33±1.74 mm; the first follow-up, 13.27±1.81mm; last follow-up, 13.16±1.76mm) and ulnar variance (postoperative, −0.10±1.29mm; the first follow-up, −0.05±1.27mm; last follow-up, −0.12±1.09mm) significantly improved as compared to the M-PCP and M-C groups. While the patients in the M-C group experienced significant re-displacement at the first and last follow-ups, in the S-PCP group, the range of wrist motion including extension (89.94±5.21%), radial deviation (90.69±6.01%), and supination (90.25±5.87%); ulnar deviation (89.81±5.82%) and QuickDASH score (2.70±3.64); and grip strength (92.50±5.59%), pronation (90.50±6.04%), and modified Mayo wrist score (90.94±4.17, the excellent rate reached up to 75%) also improved as compared to the M-PCP group, M-C group, or both groups at the last follow-up. Conclusion S-PCP improves fracture reduction and wrist function and can serve as an effective method for A2(AO/OTA) and A3 type of distal radius fractures in the elderly with limited dorsal comminution, including intra-articular fractures with displacement less than 2mm.

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The incidence of distal radius fractures in a Swedish pediatric population - an observational cohort study of 90 970 individual fractures

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04410-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hanna Südow ◽

Cecilia Mellstrand Navarro

Keyword(s):

Cohort Study ◽

Distal Radius ◽

Pediatric Population ◽

Incidence Rates ◽

Observational Cohort Study ◽

The Body ◽

Fracture Incidence ◽

Distal Radius Fractures ◽

Radius Fractures ◽

Observational Cohort

Abstract Background 40–50 % of all boys and 30–40 % of girls suffer from at least one fracture during childhood. A quarter of these fractures affects the wrist, making it the worst affected part of the body. Children often sustain the injury during play or sport activities. There has been a lifestyle change among European children during the last decades, and there is reason to believe that fracture incidence is changing. Methods For the purpose of this observational cohort study registry data was retrieved from the Swedish National Patient Register for all pediatric patients registered with a distal radius fracture during the period 2005–2013. Incidence rates were calculated for each year using data from Statistic Sweden on population size by age and gender. Results 90 970 distal radius fractures were identified. The mean age at the time of fracture was 10 years. In ages 10–17 the proportion of male patients was significantly larger. Seasonal variations were detected with peak incidences in May and September. A decreasing total fracture incidence was observed during the study period. Conclusions The incidence of distal radius fractures in a population 0–17 years in Sweden was higher among male than in female patients. The incidence was lower in 2008–2013 as compared to 2005. Further studies are necessary to reveal if the incidence will continue to decrease.

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