Background: Hand fractures are a common injury in the emergency department, and the majority of these are stable injuries that can be treated conservatively with excellent functional results. When respective injuries are characterized as unstable, surgical reduction and stabilization are necessary. The main purpose of surgical treatment of unstable hand fractures (metacarpal-phalangeal) is early mobilization to enhance hand functionality and to avoid stiffness functional incompetence. Generally, these operations are conducted under regional or general anesthesia to avoid pain and tourniquet for bloodless surgical fields. Wide Awake local anesthesia no tourniquet (WALANT) procedure is described as local injection of anesthetic agent and epinephrine without tourniquet application, with scope to allow local anesthesia without other sedation and at the same time hemostasis.
Aim: The purpose of the study is to compare the functional
assessment of the hand function during a period of three months after surgical
intervention for unstable metacarpal and phalangeal fractures under WALANT
versus Biers block.
Materials and Methods: Between May 2021 to October 2022, 43
patients with unstable metacarpal and phalangeal fractures underwent open
reduction and internal fixation, 21 cases with Biers block (BB) anesthesia and
the rest with WALANT technique. Metacarpal fractures appeared in 29 cases and
phalangeal fractures in 14 patients. Patients were operated on within the first
week of the injury. According to implants they employed locking plates, screws
and Kirschner wires in two groups. In both groups, examination with a C-arm
intensifier was performed to check the final osteosynthesis and screw sizes. A
standard rehabilitation protocol program from the first postoperative day was
applied in all patients starting from adjacent joints. Patients were trained to
follow a personalized home-based daily exercise program to increase the range
of movement and enhance muscle strength and grip strength in a later phase. The
mean quick DASH score and a Likert type of scale regarding satisfaction, three
months after the operation were measured.
Results: At three months postoperatively, Quick Dash Score is
better in the WALANT group while patients’ satisfaction does not differ between
the two groups. In the WALANT group, the immediate postoperative median VA
Score appeared 2/10, while in the Biers block group appeared to be 6/10.
Patients who underwent the WALANT technique were discharged on the same day
after the operation, while the patients with regional anesthesia were the next
postoperative day. The mean duration of analgesic use was shorter in the WALANT
group (2,3 days) than in the BB group (5,7 days).
Conclusion: Unstable metacarpal or phalangeal fractures are common
injuries with the main treatment to be open or close reduction and internal
fixations with locking plate or Kirshner wires. Οbjective of surgical treatment
of unstable hand fractures (metacarpal-phalangeal) is early mobilization and
enhanced hand functionality to avoid stiffness and tendon adhesions. Wide Awake
Local Anesthesia No Tourniquet technique is an alternative sedative procedure
which immediately offers postoperative numerous advantages (low-cost technique,
no complication from tourniquet, decreased sensation of intra or postoperative
pain) compared with Bier’s block anesthesia. Based on our results, it was
concluded that the WALANT technique offers many benefits in the surgical
treatment of hand fractures and is suggested as the first-choice
anesthesiologist procedure.
Author
(s) Details
Kastanis G
Reconstructive Hand Surgery Unit, General Hospital of Heraklion
–Venizeleio, Crete, Greece and Department of Orthopaedic, General Hospital of
Heraklion-Venizeleio, Crete, Greece.
Siligardou MK
Department of Orthopaedic, General Hospital of Heraklion-Venizeleio, Crete,
Greece.
Chaniotakis C
Department of Orthopaedic, General Hospital of Heraklion-Venizeleio, Crete,
Greece.
Tsioupros A
Department of Orthopaedic, General Hospital of Heraklion-Venizeleio, Crete,
Greece.
Pantouvaki A
Reconstructive Hand Surgery Unit, General Hospital of Heraklion
–Venizeleio, Crete, Greece, Department of Physiotherapy, General Hospital of
Heraklion-Venizeleio, Crete, Greece and Department of Nursing, Hellenic
Mediterranean University, Crete, Greece.
Kapsetakis P
Reconstructive Hand Surgery Unit, General Hospital of Heraklion
–Venizeleio, Crete, Greece.
Stavrakakis I
Department of Orthopaedic, General Hospital of Heraklion-Venizeleio, Crete,
Greece.
Please see the book here:- https://doi.org/10.9734/bpi/msti/v8/4479
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