Walant technique in wrist fractures

Abstract

Introduction

Fractures of the distal radius are one of the most common types of injuries encountered in hand surgery. Plate osteosynthesis is recommended for unstable fractures.

Distal radius fractures are treated using open reduction and internal fixation and using general anesthesia (GA) or regional blocks. Wide-awake local anesthesia with no tourniquet (WALANT), allows this operation to be conducted in non-sedated patients without the use of tourniquets.

Material and methods

We use a combination of 1% lidocaine, 1:100,000 epinephrine, and 10:1 8.4% sodium bicarbonate. However, we use only 40 mL of the prepared solution because we strictly adhere to the safe limit of 7 mg/kg for lidocaine with epinephrine. First, a total of 10 mL of subcutaneous local anesthesia is infiltrated using a 27-gauge needle along the modified Henry skin incision. We inject the solution using a 23-gauge needle at the radial border of the radius where it is easily palpable. A total of 30 mL of local anesthesia is used starting proximally with 10 mL in each injection site. It is ideal to allow the local anesthesia a duration of at least 30 minutes to take effect. It takes an average of 25 minutes for maximal cutaneous vasoconstriction to occur with 1:100,000 epinephrine.

Discussion

This technique was first introduced and popularized in the 1980's by Dr. D. Lalonde, a plastic surgeon from Canada working in hand surgery for the past 10 years. This technique relies on the injection of buffered diluted lidocaine with epinephrine at the surgical site. The tourniquet at the base of the limb, which is a source of discomfort, becomes unnecessary as the epinephrine acts as a chemical tourniquet. This technique can also help prevent the potential complications associated with regional or general anesthesia and can be used in patients who are not eligible for general anesthesia [1], [2], [3], [4], [5], [6], [7], [8], [9].

Conclusion

The WALANT technique is an easily applied, safe, and efficient anesthetic technique for open reduction and internal fixation of distal radius fractures. It does not require tourniquet so it keeps the patient free from tourniquet pain and complications. It is economical because it doesn’t require for any more expensive preoperative investigations. It does not require sedation, which allows the patients to communicate with the doctors during the procedure and perform active movement of the operated limb to examine if there is an impingement of implants.