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Case Studies | Orthopaedic Surgery | Malaysia | Volume 13 Issue 10, October 2024 | Popularity: 5 / 10
A Perioperative Prospective Study of WALANT in Open Reduction Internal Fixation of Ankle Fractures: A Malaysian Experience
Syed Azmi AS, MY Bajuri
Abstract: Introduction: The method of anaesthesia for an ORIF of the ankle includes spinal and epidural anaesthesia, general anaesthesia, peripheral nerve block and local anaesthesia with intravenous sedation, with the use of a tourniquet. The Wide - Awake anaesthesia technique alleviates the need of a tourniquet, and they can provide equivalent amount of pain control and haemostasis. Patients and methods: We report a prospective 6 - case series of patients who presented with ankle fractures that underwent ORIF with anaesthesia via the Wide - Awake Local Anaesthesia No Tourniquet (WALANT) technique. Four cases were performed in Hospital Universiti Kebangsaan Malaysia (HUKM), Cheras and the remaining 2 cases, in Hospital Cyberjaya (HCJ), Selangor between August 2023 and August 2024. The mixture was a cocktail of 50ml of Lignocaine 2%, 10ml of Sodium Bicarbonate and 1ml of adrenaline (1: 1000), added into 39ml of normal saline to render a 100ml WALANT solution. Five patients with bimalleolar fractures, 1 with an isolated lateral malleolar fracture, and 4 patients with associated syndesmotic disruptions. Results: This study reported low levels of perioperative Visual Analog Scale (VAS) with perioperative low levels of anxiety (Hamilton Anxiety Rating Scale). There were no local or systemic complications documented. One patient had 300ml of blood loss intraoperatively, possibly due to the abundant callus and fibrous tissue present as it was a delayed fixation. Conclusion: This case series demonstrated the low pain and anxiety levels experienced by patients undergoing bimalleolar ankle fracture fixation under wide - awake local anaesthesia without tourniquet. WALANT for ankle fracture ORIF is safe and provides an alternative option to reduce postoperative pain, anxiety and tourniquet related complications.
Keywords: ankle fracture, WALANT, wide - awake local anaesthesia, tourniquet, bimalleolar, lateral malleolus, medial malleolus
Edition: Volume 13 Issue 10, October 2024
Pages: 496 - 501
DOI: https://www.doi.org/10.21275/SR241006122226
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