The wide-awake local anesthesia no tourniquet (WALANT) technique in thumb injuries: a systematic review.

Human hands have a complex anatomical structure. The thumb, being an integral part of the hand, has an essential function in gripping. In this sense, thumb fractures account for 4% of all hand fractures (it may occur in association with fractures of the trapezium). The majority of hand fractures should be treated non-surgically and surgeons must avoid unnecessary surgery. Historically, hand surgery has used a combination of local/regional/general anaesthesia and a tourniquet. This study aims to carry out a systematic review to determine whether the WALANT technique is an advantageous alternative to conventional anaesthesia for surgical procedures on thumb injuries, in terms of patient function and pain. METHOD: We conducted a search in the following databases: Pubmed/Medline, EBSCOhost, Web of Science, Scopus, ScienceDirect and Google Scholar, using the equation "WALANT" OR "Wide Awake Local Anesthesia No Tourniquet" AND "thumb pathology". RESULTS: In five of the 584 articles included, two studied trapeziometacarpal osteoarthritis, one De Quervain's disease and the remaining two flexor injuries. WALANT showed good results in active movements, but with similar levels of pain between anaesthetics. Patients were more anxious during general anaesthesia, plus the fact that they were fasting and suspending medication. CONCLUSION: WALANT is a convenient and favourable option in several studies. It has been demonstrated the benefits in terms of return to function and pain.

Balance deficiencies in women with fibromyalgia assessed using computerised dynamic posturography: a cross-sectional study in Spain.

OBJECTIVES: Our aims were (1) to compare the sensory organisation of balance control and balance strategies between women with fibromyalgia (FM) and healthy women; (2) to investigate which sensory component, that is, vestibular, visual or somato-sensory, is the most affected in FM and (3) to determine the associations between the functional independence measure (FIM) and balance responses in FM. DESIGN: Cross-sectional observational study. SETTING: Urban regional hospital and university (Universidad Rey Juan Carlos, Madrid, Spain). PARTICIPANTS: Twenty women with FM and 20 matched healthy women. PRIMARY/SECONDARY OUTCOME MEASURES: The sensory organisation test (SOT) was used to determine postural sway and balance during six different conditions with subjects in a standing position. The FIM was used to determine the level of functional independence in daily life activities (ADL). Between-group differences were analysed with analysis of covariance, and the Spearman's test was used for correlations. RESULTS: Significant differences between-groups and between-conditions were found for all SOT conditions (all, p<0.001): women with FM showed lower scores being the vestibular score the most affected. Different correlations between SOT conditions and some specific ADL were observed in the FM group: bathing activity and balance condition 6 (rs=0.541; p<0.001), bed transfers activity and conditions 2 (rs=0.491; p<0.001) and 3 (rs=0.510; p<0.001), positioning strategy six and dressing the upper (rs=0.530; p<0.001) or lower (rs=0.562; p<0.001) body, and toileting (rs=0.521; p<0.001): the greater the loss of balance, the greater the interference on some daily life activities. CONCLUSIONS: Women with FM exhibited balance deficiencies and used different strategies for maintaining their balance in standing, which was associated with a negative impact on functional independence.

Influencia de la cultura en el desarrollo de la independencia funcional / Cultural influence in the development of functional independence / Influência da cultura no desenvolvimento da independência funcional

Introducción: Los aspectos culturales son considerados desde la disciplina de la Terapia Ocupacional como claves para entender el desempeño y el desarrollo. Objetivo: comparar el desempeño ocupacional entre niños sano con edades entre 3 y 7 años, en las actividades de la vida diaria entre diferentes países como son España, Noruega y Taiwán. Métodos: Se trata de un estudio comparativo entre España, Noruega y Taiwán. Ha utilizado la escala de habilidades funcionales del Pediatric Evaluation Disability Inventory (PEDI). Posteriormente se han comparado los datos de los tres mediante el uso de la prueba t no pareada de Welch. Resultados: Los resultados muestran diferencias significativas entre las tres muestras en todos los dominios de las escalas funcionales del PEDI y para todos los tramos de edad. Los niños taiwaneses puntúan más que los niños españoles y noruegos, y los españoles más que los noruegos en todos los dominios del PEDI. Conclusion: La cultura influye de forma determinante en los patrones de desarrollo en las habilidades relativas a la adquisición de la independencia en las AVDs. Antes del desarrollo de una intervención, el terapeuta ocupacional deber tener en cuenta las diferentes cuestiones relacionadas con la cultura.

Introdução: Aspectos culturais são considerados a partir da disciplina de terapia ocupacional como chaves para a compreensão do desempenho e do desenvolvimento. Objetivo: comparar o desempenho ocupacional entre as crianças saudáveis, com idades entre 3 e 7 anos, nas realização de atividades da vida diária (AVD) entre diferentes países. Método: Estudo comparativo a partir de dados da Espanha, Noruega e Taiwan. Foi utilizada a escala de habilidades funcionais da Pediatric Evaluation Disability Inventory (PEDI). Foi feita a comparação dos dados dos três países, utilizando o teste não pareado Welch. Resultados: Os resultados mostram diferenças significativas entre as três amostras em todos os domínios de escalas funcionais de PEDI e para todas as faixas etárias. Crianças de Taiwan pontuaram mais do que as crianças espanholas e norueguesas, e crianças espanholas tiveram score mais elevado do que os noruegueses em todos os domínios funcionais do PEDI. Conclusão: A cultura está muito ligada aos padrões de desenvolvimento em habilidades para a aquisição de independência em AVD. Antes do planejamento de uma intervenção, o terapeuta ocupacional deve levar em conta diferentes questões relacionadas com a cultura.

Introduction: The occupational therapy discipline considers cultural aspects as keys to understanding the performance and development. Objective: To compare occupational performance among healthy children aged 3 and 7 years in daily life activities in different countries. Method: This is a comparative study, from Spain, Norway and Taiwan. We used the Pediatric Evaluation of Disability Inventory (PEDI) scale of functional skills. Data from the three countries were compared using the Welch unpaired test. Results: The results show that there are significant differences between the three samples in all domains of the PEDI functional scales and for all age groups. Taiwanese children scored higher than Spanish and Norwegian children; and Spanish children scored higher than Norwegians in all of the PEDI functional domains. Conclusion: Culture has a decisive role in the development patterns of skills for acquiring independence in ADLs. Before planning an intervention, occupational therapist should take into account different cultural related issues.