Assessment of Hand Function during the Period of Three Months after Surgical Intervention
0Assessment of Hand Function during the Period of Three Months after Surgical Intervention for Unstable Metacarpal and Phalangeal Fractures: A Comparison between Wide Awake Local Anesthesia No Tourniquet (WALANT) Versus Bier’s Block
Layman Abstract : Broken bones in the hand are common, and many heal well with simple treatments like splints. However, some unstable fractures need surgery to properly align and fix the bones to avoid stiffness and loss of function.
This study compared two types of anesthesia for hand fracture surgery:
WALANT (Wide Awake Local Anesthesia No Tourniquet), where only the hand is numbed using local injections.
Bier’s Block (BB), which numbs the whole arm using a tourniquet.
The study included 43 patients with unstable hand fractures. All patients followed the same rehab program after surgery.
Results:
Patients in the WALANT group had better hand function after 3 months.
Pain right after surgery was lower in the WALANT group.
WALANT patients went home the same day, while the BB group usually stayed overnight.
WALANT patients needed fewer painkillers.
Conclusion:
WALANT is a safe, low-cost, and effective alternative to traditional anesthesia for hand fracture surgeries. It offers less pain, faster recovery, and fewer complications, making it the recommended first-choice for these surgeries.
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Original Abstract : Background: Hand fractures are a common injury in the emergency department, and the majority of these are stable injuries that can be treated conservatively with excellent functional results. When respective injuries are characterized as unstable, surgical reduction and stabilization are necessary. The main purpose of surgical treatment of unstable hand fractures (metacarpal-phalangeal) is early mobilization to enhance hand functionality and to avoid stiffness functional incompetence. Generally, these operations are conducted under regional or general anesthesia to avoid pain and tourniquet for bloodless surgical fields. Wide Awake local anesthesia no tourniquet (WALANT) procedure is described as local injection of anesthetic agent and epinephrine without tourniquet application, with scope to allow local anesthesia without other sedation and at the same time hemostasis.
Aim: The purpose of the study is to compare the functional assessment of the hand function during a period of three months after surgical intervention for unstable metacarpal and phalangeal fractures under WALANT versus Biers block.
Materials and Methods: Between May 2021 to October 2022, 43 patients with unstable metacarpal and phalangeal fractures underwent open reduction and internal fixation, 21 cases with Biers block (BB) anesthesia and the rest with WALANT technique. Metacarpal fractures appeared in 29 cases and phalangeal fractures in 14 patients. Patients were operated on within the first week of the injury. According to implants they employed locking plates, screws and Kirschner wires in two groups. In both groups, examination with a C-arm intensifier was performed to check the final osteosynthesis and screw sizes. A standard rehabilitation protocol program from the first postoperative day was applied in all patients starting from adjacent joints. Patients were trained to follow a personalized home-based daily exercise program to increase the range of movement and enhance muscle strength and grip strength in a later phase. The mean quick DASH score and a Likert type of scale regarding satisfaction, three months after the operation were measured.
Results: At three months postoperatively, Quick Dash Score is better in the WALANT group while patients’ satisfaction does not differ between the two groups. In the WALANT group, the immediate postoperative median VA Score appeared 2/10, while in the Biers block group appeared to be 6/10. Patients who underwent the WALANT technique were discharged on the same day after the operation, while the patients with regional anesthesia were the next postoperative day. The mean duration of analgesic use was shorter in the WALANT group (2,3 days) than in the BB group (5,7 days)....See More : https://doi.org/10.9734/bpi/msti/v8/4479
#Metacarpal_fracture #phalangeal_fractures #internal_fixation #WALANT #Biers_block