Magtoto Ian Jason, Alagar David
Hand and Microsurgery Unit, Department of Orthopedics, Philippine Orthopedic Center, Quezon City, Philippines.
J Hand Surg Glob Online. 2023 Mar 28;5(3):391-396. doi: 10.1016/j.jhsg.2023.02.006. eCollection 2023 May.
The wide-awake local anesthesia no tourniquet (WALANT) technique has been widely used for various upper extremity surgeries, but its use for surgical fixation of terrible triad injuries has yet to be reported in the literature. Two cases of terrible triad injuries surgically treated under WALANT are presented. Coronoid screw fixation and radial head replacement were performed for the first case, and radial head fixation and coronoid suture lasso were performed for the second. Intraoperative stability during the active range of motion of both the elbows was tested after fixation. Difficulties encountered included pain near the coronoid due to its deep location causing difficulty injecting local anesthetic, and shoulder pain during the surgery due to prolonged preoperative immobilization. WALANT for terrible triad fixation is a viable alternative to general and regional anesthesia in a select number of patients with the added benefit of intraoperative elbow stability testing during active range of motion.
清醒局部麻醉无止血带（WALANT）技术已广泛应用于各种上肢手术，但该技术用于治疗恐怖三联征损伤的手术固定在文献中尚未见报道。本文介绍了两例在WALANT技术下接受手术治疗的恐怖三联征损伤病例。第一例进行了冠状突螺钉固定和桡骨头置换，第二例进行了桡骨头固定和冠状突缝合套扎。固定后测试了双肘主动活动范围内的术中稳定性。遇到的困难包括冠状突位置较深，注射局部麻醉药困难，导致冠状突附近疼痛，以及术前长时间固定导致手术期间肩部疼痛。对于特定数量的患者，WALANT用于恐怖三联征固定是全身麻醉和区域麻醉的可行替代方案，其额外好处是在主动活动范围内可进行术中肘部稳定性测试。
