Department of Clinical Education, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department Orthopedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
J Orthop Surg Res. 2023 Oct 3;18(1):746. doi: 10.1186/s13018-023-04243-0.
Distal radius fractures (DRF) are frequently treated with internal fixation under general anesthesia or a brachial plexus block. Recently, the wide-awake local anesthesia with no tourniquet (WALANT) technique has been suggested as a method that results in higher patient satisfaction. This study aimed to evaluate the functional outcomes, complications, and patient-reported outcomes of DRF plating surgery under both the WALANT and balanced anesthesia (BA).
Ninety-three patients with DRFs who underwent open reduction and plating were included. Regarding the anesthetic technique, 38 patients received WALANT, while 55 received BA, comprised of multimodal pain control brachial plexus anesthesia with light general support. The patient's overall satisfaction in both groups and the intraoperative numerical rating scale of pain and anxiety (0-10) in the WALANT group were recorded. The peri-operative radiographic parameters were measured; the clinical outcomes, including Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, wrist mobility, and grip strength, were recorded in up to 1-year follow-up. Results presented with a mean difference and 95% confidence intervals and mean ± standard deviation.
The mean age of patients in the WALANT group was higher than in the BA group (63 ± 17 vs. 54 ± 17, P = 0.005), and there were fewer intra-articular DRF fractures in the WALANT group than in the BA group (AO type A/B/C: 30/3/5 vs. 26/10/19, P = 0.009). The reduction and plating quality were similar in both groups. The clinical outcomes at follow-up were comparable between the two groups, except the WALANT group had worse postoperative 3-month pronation (88% vs. 96%; - 8.0% [ - 15.7 to - 0.2%]) and 6-month pronation (92% vs. 100%; - 9.1% [ - 17.0 to - 1.2%]), and better postoperative 1-year flexion (94% vs. 82%; 12.0% [2.0-22.1%]). The overall satisfaction was comparable in the WALANT and BA groups (8.7 vs. 8.5; 0.2 [ - 0.8 to 1.2]). Patients in the WALANT group reported an injection pain scale of 1.7 ± 2.0, an intraoperative pain scale of 1.2 ± 1.9, and an intraoperative anxiety scale of 2.3 ± 2.8.
The reduction quality, functional outcomes, and overall satisfaction were comparable between the WALANT and BA groups. With meticulous preoperative planning, the WALANT technique could be an alternative for DRF plating surgery in selected patients. Trial registration This retrospective study was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-E(I)-20210201).
桡骨远端骨折（DRF）常采用全身麻醉或臂丛神经阻滞下的内固定治疗。最近，清醒镇静下无止血带（WALANT）技术被认为是一种可以提高患者满意度的方法。本研究旨在评估 WALANT 和平衡麻醉（BA）下 DRF 钢板固定术的功能结果、并发症和患者报告的结果。
纳入 93 例接受切开复位钢板内固定术的 DRF 患者。根据麻醉技术，38 例患者接受 WALANT，55 例患者接受 BA，包括多模式镇痛臂丛神经阻滞加轻度全身支持。记录两组患者的总体满意度和 WALANT 组术中疼痛和焦虑的数字评分（0-10）。测量围手术期影像学参数；记录临床结果，包括 Quick Disabilities of the Arm, Shoulder, and Hand（QuickDASH）评分、腕关节活动度和握力，随访时间长达 1 年。结果以均值差和 95%置信区间和均值±标准差表示。
WALANT 组患者的平均年龄高于 BA 组（63±17 岁 vs. 54±17 岁，P=0.005），WALANT 组关节内 DRF 骨折少于 BA 组（AO 分型 A/B/C：30/3/5 vs. 26/10/19，P=0.009）。两组的复位和钢板质量相似。两组患者的随访临床结果相似，除 WALANT 组术后 3 个月旋前（88% vs. 96%；-8.0%[-15.7 至-0.2%]）和术后 6 个月旋前（92% vs. 100%；-9.1%[-17.0 至-1.2%]）较差，术后 1 年屈曲（94% vs. 82%；12.0%[2.0-22.1%]）较好。WALANT 组和 BA 组的总体满意度相当（8.7 vs. 8.5；0.2[0.8 至 1.2]）。WALANT 组患者的注射疼痛评分为 1.7±2.0，术中疼痛评分为 1.2±1.9，术中焦虑评分为 2.3±2.8。
WALANT 和 BA 两组的复位质量、功能结果和总体满意度相当。在术前精心规划的情况下，WALANT 技术可以作为一种替代选择，用于某些患者的 DRF 钢板固定术。
本回顾性研究经高雄医学大学附设中和纪念医院机构审查委员会批准（KMUHIRB-E(I)-20210201）。
