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Application of WALANT in Diaphyseal Plating of Forearm Fractures: An Observational Study

How HM 1 , Khoo BLJ 2 , Ayeop MAS 1 , Ahmad AR 2 , Bahaudin N 2 , Ahmad AA 3

Affiliations 

  • 1 Department of Orthopaedic, Traumatology and Rehabilitation, International Islamic University Malaysia, Ministry of Health, Kuantan, Malaysia
  • 2 Department of Orthopaedics, Hospital Tuanku Ja'afar, Ministry of Health, Seremban, Malaysia
  • 3 Prince-Court Hospital, Kuala Lumpur, Malaysia
J Hand Surg Glob Online, 2022 Nov;4(6):399-407.
PMID: 36420459 DOI: 10.1016/j.jhsg.2022.02.004

Abstract

PURPOSE: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a novel anesthesia technique in distal radius and ankle fracture fixation. However, to date, there are limited studies in diaphyseal plating of forearm fractures under WALANT. This research is to study the feasibility of the use of WALANT technique in plating of diaphyseal fractures of the forearm as well as peri-operative outcomes.

METHODS: Sixty-one adult patients who underwent diaphyseal plating of the forearm under WALANT between the period of January 2019 and January 2021. It consists of 31 radius fractures, 15 ulna fractures and 15 ipsilateral radius and ulna fractures. Outcomes evaluated were duration of stay, peri-operative numerical pain rating scale, peri-operative blood pressure and heart rate, visual analogue scale for anxiety, blood loss, surgery duration, adverse effect, patient's satisfaction and any complications at 6 months follow up.

RESULTS: Fifty-four patients (88.5%) were male and 7 patients (11.5%) were female with a mean age of 31.7 years (SD = 13.564). Thirty-eight out of 61 patients were totally pain free throughout the surgery. Ten (13%) patients reported pain during muscle dissection, 14 (18%) patients reported pain during bone manipulation and 12 (16%) patients reported pain during bone drilling. There was no significant difference in pain score between radius and ulna bones (P > .05). There was a significant change in blood pressure after LA infiltration (P < .01). The mean estimated blood loss was 27.39 ml (SD = 11.44) and the mean duration of post-surgery hospital stay was 1 day (SD = 1.026). Fifty-six patients (92%) recommended diaphyseal plating of the forearm under WALANT. None of the patients required conversion to general anesthesia and had any adverse events or infection during 6 months follow up.

CONCLUSIONS: Diaphyseal plating of the forearm under WALANT is a feasible alternative anesthesia technique and is well tolerated by patients.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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