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WALANT Surgery for Fracture Fixation

Wide Awake Local Anaesthetic No Tourniquet (WALANT) hand surgery is a technique that enables safe, effective and pain-free hand surgery for almost all hand surgical indications.During the Covid-19 crisis this has been particularly useful as it reduces both staff and patient viral exposure risk, by obviating the requirement for the anaesthetic team and reducing operating room staff numbers.

Patients benefit from there being no general anaesthetic risks associated with their surgery. Rather than require a painful arm tourniquet to prevent bleeding obscuring the surgical field local anaesthetic preparation containing adrenaline is infiltrated locally. This has three beneficial effects: firstly, the adrenaline acts to constrict blood vessels, secondly the tumescent infiltration of the fluid acts to mechanically prevent bleeding, and finally the injected fluid naturally separates tissue planes making surgery easier. Note in these pictures the white ‘blanching’ of the skin showing reduced blood flow to the area, and also tracking up the arm in the lymphatic channels of the skin.
5th metacarpal #
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There are additional technical benefits for the patient and surgeon. Surgical efficacy can be checked and demonstrated in real-time between the patient and the surgeon. In this video the patient is able to demonstrate a full range of movement of their hand, with no residual rotational deformity or extensor lag, having had their unstable metacarpal fracture fixed with a plate and screws.

I am grateful to this patient for consenting to allow their images to be shared. They made a full recovery and returned to work within 2 months of their surgery.

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