Surgical Fixation of Metacarpal Shaft Fractures Using Absorbable Implants: A Systematic Review of the Literature

Background: The wide-awake local anesthesia with no tourniquet (WALANT) technique has become popularized for various hand/upper extremity procedures. Before surgery, patients receive local anesthetic, consisting of lidocaine with epinephrine, and remain awake for the entire procedure. The purpose of this review was to investigate the advantages, diverse application, outcomes, cost benefits, use in challenging environments, patient considerations, and contraindications associated with WALANT. Methods: A comprehensive review of the literature on the WALANT technique was conducted. Search terms included: WALANT, wide-awake surgery, no tourniquet, local anesthesia, hand, wrist, cost, and safety. Results: The WALANT technique has proven to be successful for common procedures such as flexor tendon repair, tendon transfer, trigger finger releases, Depuytren disease, and simple bony procedures. Recently, the use of WALANT has expanded to more extensive soft-tissue repair, fracture management, and bony manipulation. Advantages include negating preoperative evaluation and testing for anesthesia clearance, eliminating risk of monitored anesthesia care, removal of anesthesia providers and ancillary staff, significant cost savings, and less waste produced. Intraoperative evaluations can be performed through active patient participation, and postoperative recovery and monitoring time are reduced. WALANT is associated with high patient satisfaction rates and low infection rates. Conclusions: The WALANT technique has proven to be valuable to both patients and providers, optimizing patient satisfaction and providing substantial healthcare savings. As its application continues to grow, current literature suggests positive outcomes.

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“…In another study, olecranon fracture plating was successfully completed without pain using WALANT. 42 …”

Section: Diverse Applicationmentioning

confidence: 99%

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

Kurtzman

Etcheson

Koehler

2021

Plastic and Reconstructive Surgery - Global Open

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“…SRs were also conducted on biodegradable polymers such as PLA or polyglycolic acid (PGA) for bone regeneration in both animal and clinical studies [ 64 ], mandibular fixation in clinical studies [ 65 ] and fixation of metacarpal shaft fractures in clinical studies [ 23 ]. For bone regeneration, PLA was recommended to be modified by bioactive fillers such as tricalcium phosphate and hydroxyapatite [ 64 ].…”

Section: Discussionmentioning

confidence: 99%

“…For mandibular fixation, PLA implants did not provide conclusive data to support such applications in comparison with titanium plates [ 65 ]. For metacarpal shaft fractures’ fixation, PGA implants showed similar complication rates and biomechanical properties as compared with metallic implants [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Biodegradable metals for bone fracture repair in animal models: a systematic review

Zhang

Shang

Jiang

et al. 2020

Regenerative Biomaterials

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Biodegradable metals hold promises for bone fracture repair. Their clinical translation requires pre-clinical evaluations including animal studies, which demonstrate the safety and performance of such materials prior to clinical trials. This evidence-based study investigates and analyzes the performance of bone fractures repair as well as degradation properties of biodegradable metals in animal models. Data were carefully collected after identification of population, interventions, comparisons, outcomes and study design, as well as inclusion criteria combining biodegradable metals and animal study. Twelve publications on pure Mg, Mg alloys and Zn alloys were finally included and reviewed after extraction from a collected database of 2122 publications. Compared to controls of traditional non-degradable metals or resorbable polymers, biodegradable metals showed mixed or contradictory outcomes of fracture repair and degradation in animal models. Although quantitative meta-analysis cannot be conducted because of the data heterogeneity, this systematic review revealed that the quality of evidence for biodegradable metals to repair bone fractures in animal models is ‘very low’. Recommendations to standardize the animal studies of biodegradable metals were proposed. Evidence-based biomaterials research could help to both identify reliable scientific evidence and ensure future clinical translation of biodegradable metals for bone fracture repair.

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“…17 They have also been shown to provide adequate strength during the critical period for bone healing (6–8 weeks) while having complete degradation by 2–3 years postoperatively, reducing the likelihood of delayed inflammatory reactions. 42,43 The specific molecular orientation in self-reinforcing polymers provides increased strength of the composites, which allows for a thinner implant compared to nonreinforced polymers. This in turn reduces the likelihood of developing implant palpability, which would necessitate hardware removal.…”

Section: Discussionmentioning

confidence: 99%

Resorbable Implants for Mandibular Fracture Fixation: A Systematic Review and Meta-Analysis

Chocron

Azzi

Cugno

2019

Plastic and Reconstructive Surgery - Global Open

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Background:Mandibular fractures in adults commonly require rigid fixation to ensure proper occlusion while minimizing infection risks. Numerous centers have assessed the efficacy of resorbable materials as a potential alternative to metallic plates. The purpose of the current systematic review and meta-analysis is to shed light on overall outcomes for resorbable implants and to compare these results to those for metallic counterparts.Methods:A systematic review of clinical studies reporting outcomes for resorbable plates for mandible fractures was carried out. The reported outcomes were hardware failure/exposure, infection, wound dehiscence, reoperation, malocclusion, and nonunion. The results were pooled descriptively and stratified according to fracture and implant type. A subset meta-analysis of prospective studies comparing metallic and resorbable implants was also carried out.Results:Eighteen studies were included for a total of 455 patients managed with resorbable implants (mean follow-up, 8.95 months) with an overall complication rate of 19.8 % (n = 90/455). Infection (n = 31/455, 6.8%) and wound dehiscence (n = 28/455, 6.2%) were the most common complications. Nonunion occurred in 1.1% (n = 5/455) of patients. Seven studies were included in a meta-analysis, and the rates of adverse events in the resorbable and metallic groups were 18.0% (n = 32/178) and 18.3% (n = 33/180), respectively, with no statistically significant difference between both cohorts (95% CI 0.58, 1.82, P = 0.93).Conclusions:This study suggests that there are no statistical differences in outcomes for patients with mandible fractures managed with resorbable or metallic implants. In the absence of meta-analyses or large randomized controlled trials, the current study provides surgeons with an evidence-based reference to guide decision-making.

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Surgical Fixation of Metacarpal Shaft Fractures Using Absorbable Implants: A Systematic Review of the Literature

Cited by 11 publications

References 21 publications

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

Wide-awake Local Anesthesia with No Tourniquet: An Updated Review

Biodegradable metals for bone fracture repair in animal models: a systematic review

Resorbable Implants for Mandibular Fracture Fixation: A Systematic Review and Meta-Analysis

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