Adoption of the Wide-Awake Local Anesthesia No Tourniquet Technique in Hand Surgery.

¼ Wide-awake local anesthesia no tourniquet (WALANT) technique featuring tumescent infiltration of lidocaine with epinephrine at the operative site has broad application in hand surgery including both soft-tissue and bone procedures.¼ The advantages of wide-awake anesthesia include high patient satisfaction, preserved intraoperative finger and wrist motion, cost-effectiveness, improved operating room efficiency, fewer opioids during recovery, and improved access to hand surgery, which may be performed in an office-based setting without the need for anesthesia personnel.¼ In properly selected patients, use of lidocaine with epinephrine in the hand and fingers is safe. Rare postprocedure digital ischemia may be effectively treated with phentolamine rescue.¼ Barriers to adopting wide-awake anesthesia may be overcome by educating resistant stakeholders, including hospital administrators, nurse leaders, and anesthesia colleagues, about the advantages of the WALANT method.¼ The risk of postoperative complications after hand procedures may be mitigated by using the wide-awake technique instead of regional anesthesia with sedation or general anesthesia.

Stacked 1/3 Tubular Plates for Fixation of Pediatric Forearm Fractures: A Biomechanical Study.

Introduction: Among operatively treated pediatric forearm fractures, many different fixation constructs are described. The goal of this study was to define the biomechanical properties of a double stacked 1/3 tubular plate construct used by the senior author for some fractures and to review available literature regarding the use of stacked plates. Methods: Biomechanical testing was performed by 4-point bending of three different plate constructs: 1/3 tubular plate, stacked 1/3 tubular plates, and 2.7 mm LC-DCP plate. Five test specimens were evaluated for each of the three plate constructs. From stress-strain curves, flexural stiffness (N/mm), force to cause plastic deformation (N), and force to cause 10° bend (N) were calculated and compared using standard t-test statistics. Results: Key outcome parameter means (± SD) for the three plate constructs (1/3 tubular plate, stacked 1/3 tubular plates, and 2.7 mm LC-DCP plate) were reported respectively as follows: flexural stiffness (55.4 ± 3.5 N/mm, 131.7 ± 3.5 N/mm, 113.3 ± 12.1 N/mm), force to cause plastic deformation (113.6 ± 11.0 N, 242.1 ± 13.0 N, 192.2 ± 17.9 N), and force to cause a 10° bend (140.0 ± 8.4 N, 299.4 ± 14.1 N, 265.5 ± 21.2 N). Mean values of all three measures were significantly larger for the stacked 1/3 tubular plates than for the other plate constructs. Conclusions: The stacked 1/3 tubular plate construct was biomechanically superior to the other plate constructs tested. Stacked plating significantly improved stiffness of the fracture fixation construct supporting the use of this technique in selected trauma cases.