Comparison of distal radius fracture plating surgery under wide-awake local anesthesia no tourniquet technique and general anesthesia: A retrospective cohort study

Abstract Background Distal radius fractures (DRF) are frequently treated with internal fixation under general anesthesia (GA) or a brachial plexus block. Recently, the wide-awake local anesthesia with no tourniquet (WALANT) technique has been suggested as a method that results in higher patient satisfaction. This study aimed to evaluate the functional outcomes, complications, and patient-reported outcomes of DRF plating surgery under both the WALANT and GA methods. Methods Ninety-three patients with DRFs who underwent open reduction and plating were included. Regarding the anesthetic technique, 38 patients received WALANT, while 55 received GA. The patient's overall satisfaction in both groups and the intraoperative numerical rating scale of pain and anxiety (0 to 10) in the WALANT group were recorded. The peri-operative radiographic parameters were measured; the clinical outcomes, including Quick Disabilities of the Arm, Shoulder, and Hand ( Quick DASH) score, wrist mobility, and grip strength, were recorded in up to 1-year follow-up. Results presented with a mean difference and 95% confidence intervals (CIs). Results The mean age of patients in the WALANT group was higher than in the GA group (63±17 vs. 54±17, P<0.01), and there were fewer intra-articular DRF fractures in the WALANT group than in the GA group (AO type A/B/C: 30/3/5 vs. 16/10/19, P<0.01). The reduction and plating quality were similar in both groups. The clinical outcomes at follow-up were comparable between the two groups, except the WALANT group had worse postoperative 3-month pronation (88% vs. 96%; -8.0% [-15.7 to -0.2%]) and 6-month pronation (92% vs. 100%; -9.1% [-17.0 to -1.2%]), and better postoperative 1-year flexion (94% vs. 82%; 12.0% [2.0 to 22.1%]). The overall satisfaction was comparable in the WALANT and GA groups (8.7 vs. 8.5; 0.2 [-0.8 to 1.2]). Patients in the WALANT group reported an injection pain scale of 1.7±2.0, an intraoperative pain scale of 1.2±1.9, and an intraoperative anxiety scale of 2.3±2.8. Conclusion The reduction quality, functional outcomes, and overall satisfaction were comparable between the WALANT and GA groups. With meticulous preoperative planning, the WALANT technique could be an alternative to GA for DRF plating surgery in selected patients. Trial registration This retrospective study was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-E(I)-20210201).