Wide-awake surgery in orthopaedics: "Scoping review".

INTRODUCTION: The anaesthetic modality "wide-awake" or "WALANT" (wide awake local anaesthesia not tourniquet) is based on the combination of a local anaesthetic with a vasoconstrictor to reduce bleeding during surgery and to avoid the use of a pneumatic tourniquet. The combination of 1% lidocaine together with 1:100,000 epinephrine is the most commonly used formula. The objective of this work is to carry out a review of the literature about this anaesthetic modality in the field of orthopaedic surgery and traumatology. METHODS: PubMed and Embase databases were consulted with clearly defined operators. Two independent searches were conducted by two investigators, which were combined. Experimental, observational comparative studies, descriptive studies with n> 5 cases and cost studies were included. The individual results of the included studies are described. RESULTS: A total of 8794 entries were collected of which a total of 36 studies were included in the review. A large number of these studies have been published since 2010 and refer almost entirely to hand surgery, with multiple indications applied. There is heterogeneity regarding the type of study design and variables studied, among others. In addition, there is a disparity when defining the methodology of the WALANT technique between the different studies. CONCLUSIONS: This is the first comprehensive and reproducible review of the current state of the WALANT modality. There is great heterogeneity in terms of the study populations, the different comparators, variables studied between the different studies and a lack of precise details regarding the WALANT technique. LEVEL OF EVIDENCE: III, Therapeutic study.

A customized percutaneous three-dimensional-printed guide for scaphoid fixation versus a freehand technique: a comparative study.

The aim of this study was to compare the accuracy and reliability of percutaneous fixation of minimally displaced scaphoid fractures using a customized three-dimensional (3-D)-printed guide with a conventional freehand method. A prospective cohort of ten patients underwent scaphoid fixation with the aid of a customized 3-D-printed guide. The final screw position, total surgery time (minutes) and fluoroscopy time (seconds) was compared with a retrospective cohort of ten patients who underwent fixation with a conventional technique. There were no differences in final screw position between both methods. The patients in which the 3-D guide was used had a surgery time reduction of 43% and a fluoroscopy time reduction of 52% compared with the control freehand group. The use of a customized 3-D-printed guide permits a fixation that is as accurate as the standard freehand technique, with reduction in surgical time and intraoperative radiation exposure.Level of evidence: III.

Partial Versus Total Trapeziectomy With Interposition Arthroplasty for Trapeziometacarpal Osteoarthritis Grade II to III Eaton-Littler: A Clinical Trial.

Purpose: Total trapeziectomy is the most widely used technique to treat isolated thumb trapeziometacarpal joint osteoarthritis. However, this technique has been associated with proximal migration of the thumb metacarpal, which has led some physicians to consider partial trapeziectomy as a valid alternative. The purpose of this study was to assess whether partial trapeziectomy improves final key pinch strength compared with total trapeziectomy. Methods: We randomized 34 patients with basal thumb osteoarthritis into 2 groups to undergo partial or total trapeziectomy with interposition arthroplasty. Key pinch strength at 12 months was the primary outcome measure. Other variables measured included trapezial space height, range of motion, grip strength, change in key pinch strength, patient-reported outcome measures, and pain. Results: No difference between groups was detected regarding final pinch strength, trapezial space height, grip strength, range of motion, change in pinch strength, patient-reported outcomes (Quick-Disabilities of the Arm, Shoulder, or Hand), or pain. Conclusions: We cannot conclude that partial trapeziectomy provides an advantage over total trapeziectomy at 1 year after surgery. Although trapeziometacarpal space was substantially preserved in the partial trapeziectomy group at 12 months, this difference was not statistically or clinically significant. Type of study/level of evidence: Diagnostic III.

Long-Term Evaluation Following Partial Trapeziectomy and Suspension Arthroplasty for Trapeziometacarpal Osteoarthritis: An Observational Study.

Purpose: Partial trapeziectomy is performed to decrease the risk for first ray collapse. However, the incidence of scaphotrapezoidal (ST) joint osteoarthritis (OA) in the presence of advanced trapeziometacarpal joint OA is around 40%. The purposes of this study were to analyze the progression of the ST joint after partial trapeziectomy and to establish the potential link between radiographic findings and patient outcomes. Methods: We reviewed a series of 22 patients (26 thumbs) with base of the thumb OA who underwent partial trapeziectomy and interposition arthroplasty. Standardized radiographs of the ST joint were classified by 2 independent observers. Measured outcomes were pain, mobility (degrees of abduction, Kapandji score, and anteversion [in centimeters]), force (in kilograms]) and the short version of the Disabilities of the Arm, Shoulder, and Hand questionnaire score. Results: Median follow-up was 8 years. The modified Eaton-Glickel scale was used to rate the degree of ST joint arthritis: 2 thumbs were classified as grade 1, 11 as grade 2, 12 as grade 3, and 1 as grade 4. No parameters analyzed demonstrated a statistically significant correlation between patients' outcomes and joint radiographic arthritis. Conclusions: Our study cannot demonstrate that the radiographic presence of ST arthritis correlates with the patient's main symptoms after partial trapeziectomy. Type of study/level of evidence: Therapeutic IV.