RESUMO
Purpose: Wide-Awake Local Anesthesia No Tourniquet (WALANT) is a novel anesthesia technique in distal radius and ankle fracture fixation. However, to date, there are limited studies in diaphyseal plating of forearm fractures under WALANT. This research is to study the feasibility of the use of WALANT technique in plating of diaphyseal fractures of the forearm as well as peri-operative outcomes. Methods: Sixty-one adult patients who underwent diaphyseal plating of the forearm under WALANT between the period of January 2019 and January 2021. It consists of 31 radius fractures, 15 ulna fractures and 15 ipsilateral radius and ulna fractures. Outcomes evaluated were duration of stay, peri-operative numerical pain rating scale, peri-operative blood pressure and heart rate, visual analogue scale for anxiety, blood loss, surgery duration, adverse effect, patient's satisfaction and any complications at 6 months follow up. Results: Fifty-four patients (88.5%) were male and 7 patients (11.5%) were female with a mean age of 31.7 years (SD = 13.564). Thirty-eight out of 61 patients were totally pain free throughout the surgery. Ten (13%) patients reported pain during muscle dissection, 14 (18%) patients reported pain during bone manipulation and 12 (16%) patients reported pain during bone drilling. There was no significant difference in pain score between radius and ulna bones (P > .05). There was a significant change in blood pressure after LA infiltration (P < .01). The mean estimated blood loss was 27.39 ml (SD = 11.44) and the mean duration of post-surgery hospital stay was 1 day (SD = 1.026). Fifty-six patients (92%) recommended diaphyseal plating of the forearm under WALANT. None of the patients required conversion to general anesthesia and had any adverse events or infection during 6 months follow up. Conclusions: Diaphyseal plating of the forearm under WALANT is a feasible alternative anesthesia technique and is well tolerated by patients. Type of study/level of evidence: Therapeutic III.
RESUMO
Simultaneous ipsilateral fractures involving all the bones around the shoulder girdle, namely, the scapula, clavicle and humerus, are rare. We describe an interesting case of a 31-year-old patient who presented after a motor vehicle accident with excruciating pain over his left shoulder and a flail left upper limb. Radiographs and computed tomography (CT) scan revealed the presence of comminuted left scapula, clavicle and proximal humerus fractures. He was also diagnosed with a complete brachial plexus injury of the left shoulder. The patient underwent a tedious surgery involving screw fixation and plating of the scapula, clavicle and proximal humerus. Despite achieving stable fixations of the shoulder and radiographic union of all the fractures, he did not recover from the complete brachial plexus injury 14 months after the trauma. The presence of ipsilateral clavicle, scapula and humerus fracture suggests involvement in high-energy trauma, and therefore, associated injuries especially neurovascular compromise should not be missed. Despite its rarity, management of this complex injury should always be individualised to ensure optimal functional outcomes are achieved.
