No abstract

This study compared outcomes of plating distal radius (DR) fractures using wide-awake local anesthesia no tourniquet (WALANT) versus general anesthesia (GA). Methods: From March 2018 to March 2019, 20 patients with DR fracture underwent plating using WALANT whereas 20 patients who underwent plating under GA were used as controls. Outcomes evaluated were pain control, waiting time for the operation, hemodynamic changes, blood loss, the occurrence of adverse effects of medications used in WALANT and GA, and the duration of postoperative stay. Results: The WALANT group experienced a significantly shorter waiting time for surgery (6 vs 20 days; P < .001) and a shorter postoperative stay (1 vs 2 days; P ¼ .009) compared with the GA group. They also reported mild to no pain during surgery. The groups were similar with regard to blood pressure, blood loss, and operative time. None in the WALANT group required conversion to GA during surgery and no adverse effects were reported. Conclusions: The WALANT approach is a viable alternative to GA for plating of DR fractures. Type of study/level of evidence: Therapeutic III.

Objectives: Patients_with_traumatic_brain_or_spinal_cord injury are at risk of developing peri-articular NHO most frequently affecting the hip; with resulting ankyloses and functional limitations1. Surgical excision aims to improve functional ability and facilitate nursing care2. It is technically challenging as NHO development maybe multi-focal and multi-directional around the joint involving important neuro-vascular structures2. Plain_radiographs often provide sub-optimal_information_required_for_surgical planning Methods: An_18-year-old_male_presented to us with pain and immobility of his right hip 18-months following a traumatic brain injury. The joint was completely ankylosed and he was unable to walk. Plain radiograph showed extensive NHO from medial aspect of right proximal femur to ischial tuberosity (Figure_1). A CT scan with 3D reconstruction more clearly defined the NHO as extending posteriorly from the greater trochanter to ipsilateral pubic ramus and ischial tuberosity (Figures 2a & 2b). We therefore opted_for_a_Kocher-Langenback approach and performed selective excision to achieve satisfactory_range of motion. RESULTS: The_Kocher-Langenbeck_approach_enabled_us to visualise and access a major segment of the bone bridge. Excision of NHO began at the proximal end of the femur with aim to break the bone bridge between the femur and pelvis to enable hip movement (Figure 3). Limited excision was performed until satisfactory range of motion of hip is achieved as assessed intraoperatively. This is to reduce risk of iatrogenic sciatic nerve injury. 3 months following_surgery, the_patient is now weight bearing_with_80_degrees_of_hip_flexion_with good_internal_and_external_rotation. Conclusion: CT_scanning_with_3D reconstruction should be performed prior to excision of hip NHO as it aids the surgeon in planning the appropriate approach and avoid iatrogenic injury to_adjacent_structures.