Corrective Osteotomies for Digital Overlap in Phalangeal and Metacarpal Fracture Malunion Using Wide Awake Local Anesthesia No Tourniquet (WALANT) Technique: A Technical Note.

The use of wide-awake local anesthesia with no tourniquet (WALANT) in surgical procedures of the hand is well described and extends to tendon surgery, carpal tunnel release, trapeziectomy and phalangeal fracture fixation. Its use has not been described in corrective osteotomies of phalangeal or metacarpal fracture malunion. In our series of five patients who underwent phalangeal and metacarpal osteotomies under WALANT, all of the patients achieved union at a mean of 3.5 months and were satisfied with the results. All digital malrotations were corrected. There was an improvement of motion and grip strength by 24% and 29.3% respectively compared to pre-surgery. Corrective osteotomies under WALANT is a safe and effective means of achieving correction of scissoring. With the patient wide awake and cooperating, precise correction of rotational alignment can be ascertained. Concomitant tenolysis allows motion gains to be made over and above the restoration of rotational alignment.

Emergency Hand and Reconstructive Microsurgery in the COVID-19-Positive Patient.

The case spectrum in hand surgery is one of extremes-purely elective day surgery cases under local anesthesia to mangling limb injuries that require immediate, and frequently, lengthy, surgery. Despite the cancellation of most elective orthopedic and plastic surgical procedures, hand surgeons around the world continue to see a steady stream of limb-threatening cases such as severe trauma and infections that require emergent surgical care. With the increase in community-spread, an increasing number of COVID-19-infected patients may be asymptomatic or have mild, nonspecific or atypical symptoms. Some of them may already have an ongoing, severe infection. The time-sensitive nature of some of these cases means that hand surgeons may need to operate urgently on patients who may be suspected of COVID-19 infections, often before confirmatory test results are available. General guidelines for perioperative care of the COVID-19-positive patient have been published. However, our practices differ from those of general orthopedic and plastic surgery, primarily because of the focus on trauma. This article discusses the perioperative and technical considerations that are essential to manage the COVID-19 patient requiring emergency care, without compromising clinical outcomes and while ensuring the safety of the attending staff.