Retrospective evaluation of WALANT in emergency hand surgery in the Bordeaux university hospital.

The Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique uses local anesthesia based on lidocaine and adrenaline, enabling surgery without the tourniquet normally used in hand surgery. Only a few studies have been conducted on the use of WALANT for emergency hand surgery in teaching hospitals. We therefore set up the WALANT procedure in our emergency department in the university hospital of Bordeaux, France, to evaluate its feasibility and the satisfaction of patients and operators. Between April and June 2020, we included 58 patients undergoing surgery for acute trauma of the hand/wrist. WALANT was performed following a specific protocol. A tourniquet was systematically available on standby. After the procedure, patients and operators were asked to complete a questionnaire. Patients rated pain on a 0-10 numerical analog scale. Surgeons reported their feelings about bleeding and patient cooperation. All patients underwent a nearly painless operation, with a mean pain score of 0.36/10. The mean pain score during injection was 2.57, and postoperatively 5.2. Bleeding complications were reported to be absent or slight by 43% of operators, moderate but acceptable by 47%, and significant by 10%. Bipolar forceps were used in 76% of cases. No digital necrosis or prolonged ischemia requiring the use of phentolamine was reported. WALANT offers a simple, safe, and effective alternative to traditional anesthesia techniques in an emergency setting. Patients and surgeons reported overall satisfaction, with no increase in the complications rate.

Angular stable plate versus reverse shoulder arthroplasty for proximal humeral fractures in elderly patient.

BACKGROUND: Treatment of complex proximal humeral fractures in the elderly is a challenge and reverse shoulder arthroplasty (RTSA) is now an important alternative to open reduction internal fixation (ORIF) with angular stable plate. The purpose of this study is to compare clinical and radiological outcomes of RTSA and ORIF in the elderly. METHODS: We retrospectively analyzed patients treated for three- or four-part displaced fractures of the proximal humerus. Range of motion, disabilities of the arm, shoulder and hand (DASH) and Constant scores were recorded. X-ray exam in three projections completed the clinical observation at follow-up. RESULTS: Forty-eight patients were enrolled after a mean follow-up of 37 months: 22 RTSA and 26 ORIF. Mean age at trauma was 74 years. Compared with RTSA patients, ORIF patients had significantly higher mean external rotation (28° vs. 14°) and better results in modal internal rotation (hand at D7 vs. hand at L5-S1). No significant differences were seen in DASH and Constant scores. Avascular necrosis and loss of reduction with varus dislocation of the humeral head were the most frequent causes of revision surgery in ORIF (34.6%) while the revision rate of the RTSA was 9.1%. CONCLUSION: In this study, both treatments showed good clinical outcomes, but RTSA resulted in lower revision rate than ORIF. Even if external and internal rotation in RTSA patients were worse than ORIF, they did not affect the patient's quality of life. So, the reverse arthroplasty seems to be a more reliable treatment.