Open reduction and internal fixation of ankle fracture using wide-awake local anaesthesia no tourniquet technique |
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| Affiliation: | 1. Department of Orthopedics, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 81362, Taiwan, ROC;2. Department of Biomedical Engineering, I-Shou University, Taiwan, ROC;3. Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC;1. Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA;2. Department of Orthopaedics, Atrium Health, Charlotte, NC, USA;3. Department of Orthopaedics and Physical Rehabilitation, University of Massachusetts, Worcester, MA, USA;1. Graduate Program on the General Bases of Surgery, Botucatu Medical School, Department of Anatomy, Universidade Estadual Paulista “Júlio de Mesquita Filho”, São Paulo State University (Unesp), Institute of Biosciences, Travessa da Rua Prof. Dr. Gilberti Moreno São Paulo, 18618-689, Botucatu, Brazil;2. Department of Anatomy, Universidade Estadual Paulista “Júlio de Mesquita Filho”, São Paulo State University (Unesp), Institute of Biosciences, Travessa da Rua Prof. Dr. Gilberti Moreno São Paulo, 18618-689, Botucatu, Brazil;3. The Center for the Study of Venoms and Venomous Animals, UNESP, Botucatu, SP, Brazil;4. Unifai-Centro Universitário de Adamantina, Adamantina, SP, Brazil;1. Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, 20 West Temple Road, Nantong 226001, Jiangsu, China;2. Department of Hand Surgery, Tianjin Hospital, 406 Jiefang Nan Road, Hexi District, Tianjin 300211, China;1. Dalhousie University, 100 Tucker Park Road, P.O. Box 5050, Saint John, NB E2L 4L5, Canada;2. University of New Brunswick, 100 Tucker Park Road, P.O. Box 5050, Saint John, NB E2L 4L5, Canada;3. Horizon Health Network, 560 Main Street, Building A, Suite 325, Saint John, NB E2K 1J5, Canada |
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| Abstract: | ![]()
IntroductionAnkle fractures frequently occur and must be treated with open reduction for long-term stability. The existing anaesthesia methods include general anaesthesia, spinal and epidural anaesthesia, peripheral nerve block and local anaesthesia with IV sedation. However, each method has its inherent risks and potential costs, and the use of a tourniquet is inevitable. Therefore, the wide-awake local anaesthesia no tourniquet (WALANT) technique provides an alternative method for equivalent haemostasis and pain control without the use of a tourniquet.Patients and methodsWe prospectively enrolled 13 consecutive patients (9 males and 4 females) who presented ankle fractures and required ORIF from January 2017 to December 2017. The fracture types of the 13 patients included lateral malleolar fracture (three patients), bimalleolar fracture (two patients), bimalleolar equivalent fracture (three patients), medial malleolar fracture (two patients) and trimalleolar fracture (three patients; articular surface involvement <25%). We used a solution of 1% lidocaine mixed with 1:40,000 epinephrine for WALANT.ResultsAll patients underwent surgery if they exhibited an initial numerical pain rating scale (NPRS) score of 0 without using a tourniquet. Only two patients required an additional 5 ml of local anaesthesia due to NPRS score elevation during the surgery; no dose exceeded the safe limit of 7 mg/kg. No local complications occurred, and no shifts to other anaesthesia methods were required due to the failure of WALANT.ConclusionsWALANT simplified surgical preparations and provided a safe and reliable method for ankle fracture management. Because the use of a tourniquet was not required, reduced postsurgical pain was observed. Moreover, the use of local anaesthesia resulted in more satisfied patients and facilitated easier recovery. |
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| Keywords: | Ankle fracture Wide-awake WALANT |
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