BackgroundThe wide-awake local anesthesia no tourniquet (WALANT) technique is applied during various hand surgeries. We investigated the perioperative variables and clinical outcomes of open reduction and internal fixation (ORIF) for distal radius fractures under WALANT.MethodsFrom January 2015 to January 2017, 60 patients with distal radius fractures were treated, and 24 patients (40% of all) were treated with either a volar or a dorsal plate via WALANT procedure. Of these 24 patients, 21 radius fractures were fixed with a volar plate, and the other 3 were fixed with a dorsal plate. Radiographs; range of motions; visual analog scale (VAS); quick disabilities of the arm, shoulder, and hand (Quick DASH) questionnaire; and time to union were evaluated.ResultsOne of the 24 patients could not tolerate the WALANT procedure and was reported as a failed attempt at WALANT. In the cohort, 23 patients successfully received distal radius ORIF under WALANT procedure. The average age is 60.9 (range, 20–88) years. The average operation time was 64.3 (range, 45–85) minutes, the average blood loss was 18.9 (range, 5–30) ml, and the average of duration of hospitalization is 1.8 (range, 1–6) days. The average postoperative day one VAS was 1.6 (range, 1–3). The average time of union was 20.7 (range, 15–32) weeks. The mean follow-up period was 15.1 (range, 12–24) months. Functional 1-year postoperative outcomes revealed an average Quick DASH score of 7.60 (range, 4.5–13.6) and an average wrist flexion and extension of 69.6° (range, 55–80°) and 57.4° (range, 45–70°). There was no wound infection, neurovascular injury, or other major complication noted.ConclusionsWALANT for distal radius fracture ORIF is a method to control blood loss by the effects of local anesthesia mixed with hemostatic agents. Without a tourniquet, the procedure prevents discomfort caused by tourniquet pain. Without sedation, patients could perform the active range of motion of the injured wrist to check if there is impingement of implants. It eliminates the need of numerous preoperative examinations, postoperative anesthesia recovery room care, and side effects of the sedation. However, patients who are not amenable to the awake procedure are contraindications.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0903-1) contains supplementary material, which is available to authorized users.

BackgroundHere, we compared the clinical and radiographic outcomes between coracoclavicular (CC) fixation with Mersilene tape and hook plate for acute unstable acromioclavicular (AC) joint dislocation treatment.MethodsWe enrolled 49 patients with unstable acute AC dislocation who, between January 2010 and January 2014, underwent surgery with single CC suture fixation with Mersilene tape (M group, 25 cases) or clavicle hook plate (H group, 24 cases). In M and H groups, the average age was 43.7 (range 18–72) and 42.0 (range 17–84) years, the male to female ratio of each group was 15:20 and 19:5, and the injured side left to right ratio was 12:13 and 11:13, respectively. All patients were right-handed. We retrospectively compared the operation time, complication rate, visual analog scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, Oxford shoulder scores, and the radiographic outcomes based on reduction loss of CC distance on postoperative follow-up.ResultsNo significant difference in patient demographics between the two groups in age (p = 0.709), gender (p = 0.217), time from injury to surgery (p = 0.863), and injured side (p = 1.000). The mean follow-up was 26.2 months (range 24–35 months). Nine cases of reduction loss (36%) and one of distal clavicle osteolysis (4%) were noted in the M group. CC distance improvement in the H group was significantly superior to that in the M group at 3 months (before hook plate removal, p < 0.001) and 12 months postoperatively (after hook plate removal, p = 0.004), while subacromial erosions were revealed in nine cases (37.5%) in the H group. No significant difference in operative time (p = 0.846), complication rate (p = 1.000), VAS (p = 0.199), mean UCLA shoulder rating scale (p = 0.353), and Oxford shoulder (p = 0.224) scores between the two groups.ConclusionsBoth hook plate and Mersilene tape fixations provided temporary stabilization of acute type V AC dislocation and yielded comparable clinical outcomes. The hook plate provided better maintenance of reduction of radiographic outcomes. CC suture fixation with Mersilene tape may serve as an alternative method of stabilization which provides acceptable outcome without the need of implant removal.

BackgroundTibial plateau fracture (TPF) includes different fracture patterns with varied degrees of articular depression and displacement. Many kinds of fixators, including newly designed plate with locking screws, were applied to treat these complicated fractures. We intended to follow up the surgical outcomes of (1) unilateral locking plate, (2) classic dual plates, or (3) hybrid dual plates for TPF.Materials and methodsWe retrospectively reviewed 76 patients with TPF, Schatzker types V and VI, who we operated from June 2006 to May 2009 in our institute. Excluding patients who expired due to other medical conditions and without complete follow-up, 45 patients were sorted out in this series. The scheme of surgical intervention was designed by visiting staff, and 15 patients, as group I, were treated with unilateral locking plate. The other 19 patients, as group II, were treated with classic dual plates. The residual 11 patients, as group III, were treated with hybrid dual plates (one lateral approach locking compression plate (LCP) + medial anti-gliding plate). All patients were under periodic F/U at about 6 weeks interval for at least 18 months postoperatively.ResultsIn group I, 13 cases achieved solid bony union without obvious traumatic OA change, limitation of ROM, or malalignment. In groups II and III, 15 and 10 patients reached the same goal, respectively. By analysis of the recorded parameters with statistical software (SPSS 12.0), there were five parameters with significant difference, including Schatzker classification, operation time, staged treatment or not, hospitalization period, and hardware impingement.ConclusionsThere was no significant statistical difference of union rate between these three groups in our series. Based on our clinical follow-up, several key points were emphasized: (1) Soft tissue problems should be kept in mind, and usage of locking plate can reduce the discomfort of hardware impingement effectively. (2) The single lateral approach technique for TPF with locking plate results in less operation time and shorter hospitalization period. (3) If the medial buttress cannot be established by reduction of the lateral fracture, then open reduction of the medial side is necessary and buttresses the medial fragment by dual plates.

The prone position and direct posterior approach has great advantages in terms of reduction and stable fixation, yielding good results.

Post-traumatic large bone defects of more than 4 cm occur sometimes in open lower extremity fractures. Management of this kind trauma can be a challenge to orthopedic surgeons. We have managed this kind of bone defect by the use of free non-vascularized fibular strut bone grafts (FNVFG) harvested subperiosteally and held by screw fixation of the strut ends to the ends of the bone defect. Ten patients, eight males and two females, with a mean age of 44 years (range 26-76 years) underwent this procedure. The length of defect was 7.0 cm on average (ranging from 4 to 8 cm). Ten grafts (100%) united at both ends within an average of 6 months (range 5-9 months). Nine patients walked independently, and one patient walked with a stick. FNVFG is a simple procedure and a reliable method to bridge huge bone loss due to open fractures of lower extremities successfully in selected cases.