ABSTRACT
Purpose: Wide-awake local anesthesia with no tourniquet (WALANT) as a walk-in procedure has become a standard technique in open carpal tunnel release (OCTR) and continues to replace the long-established intravenous regional anesthesia with a tourniquet (IVRA/"bier-block") in our clinic. The aim of this study was to compare patient satisfaction with either WALANT or IVRA/"bier-block" and define subgroups that are particularly suited for either of the two procedures. We hypothesized that older patients would prefer IVRA because of a shorter period of postoperative surveillance. Methods: In this retrospective study we evaluated patient satisfaction with either WALANT or IVRA using an adjusted questionnaire on a standard Swiss grading system (from 1 = insufficient/very strong pain to 6 = excellent/no pain). Secondary outcomes included postoperative pain or satisfaction with the tourniquet and quality of postoperative care. Results: For the 176 patients (WALANT, n = 109; IVRA, n = 67) included in the study, there was high patient satisfaction with both procedures (WALANT, 5.5/6; IVRA, 5.5/6). Patients aged 80 years and older had significantly less postoperative pain after WALANT (WALANT, 5.8/6 vs IVRA, 4.9/6). Conclusions: Patients aged 80 years and older had significantly less postoperative pain after WALANT than that after IVRA. Here, sarcopenia may have contributed to the prolonged discomfort after tourniquet application. Immediate postoperative discharge after WALANT did not negatively affect older patients. Clinical relevance: For OCTR, WALANT as a walk-in procedure is a safe and comfortable alternative to IVRA, which is commonly planned with short postoperative surveillance. Both anesthesia techniques are suitable for all ages and sexes but based on this study we recommend WALANT as a tourniquet-free operation in older patients.
ABSTRACT
PURPOSE: To assess the complications after plate fixation of phalangeal fractures, their correlation with the type of injury, and the outcome. METHODS: We retrospectively reviewed the clinical records and the x-rays of 54 consecutive patients with 64 phalangeal fractures treated by open reduction and plate fixation with regard to fracture healing, plate loosening or failure, infection, complex regional pain syndrome, pain, return to work, and range of motion. RESULTS: In 31 out of 54 patients (57%) and 33 out of 64 fractures (52%), one or more major complications occurred. Stiffness (definition is composite range of motion of metaphalangeal, proximal interphalangeal, and distal interphalangeal joints added together equaling <180 degrees) contributed the highest number (22 patients, 24 fractures). The complication rates were not different whether the fracture was open or closed, if it was located in the proximal or middle phalanx, the presence or absence of an associated soft tissue lesion, and the patient's occupation. CONCLUSIONS: In spite of early mobilization, stiffness is the most frequent complication after open reduction and plate fixation of phalangeal fractures. The undue amount of scarring and adhesion may arise from the implant itself or the difficulty in finding the perfect mixture between the minimal surgical invasiveness and a sufficient restoration of skeletal stability. Otherwise, plate fixation of unstable and complex phalangeal fractures proved efficient and reliable, although not free of potential problems.
