Fractures of the distal radius are one of the most common types of injuries encountered in hand surgery. Plate osteosynthesis is recommended for unstable fractures.

Distal radius fractures are treated using open reduction and internal fixation and using general anesthesia (GA) or regional blocks. Wide-awake local anesthesia with no tourniquet (WALANT), allows this operation to be conducted in non-sedated patients without the use of tourniquets.

We use a combination of 1% lidocaine, 1:100,000 epinephrine, and 10:1 8.4% sodium bicarbonate. However, we use only 40mL of the prepared solution because we strictly adhere to the safe limit of 7mg/kg for lidocaine with epinephrine. First, a total of 10mL of subcutaneous local anesthesia is infiltrated using a 27-gauge needle along the modified Henry skin incision. We inject the solution using a 23-gauge needle at the radial border of the radius where it is easily palpable. A total of 30mL of local anesthesia is used starting proximally with 10mL in each injection site. It is ideal to allow the local anesthesia a duration of at least 30minutes to take effect. It takes an average of 25minutes for maximal cutaneous vasoconstriction to occur with 1:100,000 epinephrine.

This technique was first introduced and popularized in the 1980's by Dr. D. Lalonde, a plastic surgeon from Canada working in hand surgery for the past 10 years. This technique relies on the injection of buffered diluted lidocaine with epinephrine at the surgical site. The tourniquet at the base of the limb, which is a source of discomfort, becomes unnecessary as the epinephrine acts as a chemical tourniquet. This technique can also help prevent the potential complications associated with regional or general anesthesia and can be used in patients who are not eligible for general anesthesia [1Lalonde D. Wide Awake Hand Surgery  : Thieme Publishers (2015). 

Cliquez ici pour aller à la section Références, 2Lalonde D., Eaton C., Amadio P.C., Jupiter J.B. Wide-awake hand and wrist surgery: a new horizon in outpatient surgery Instr Course Lect 2015 ;  64 : [249e259].

Cliquez ici pour aller à la section Références, 3Hyatt B.T., Rhee P.C. Wide-awake surgical management of hand fractures: technical pearls and advanced rehabilitation Plast Reconstr Surg 2019 ;  143 (3) : [800e810].

Cliquez ici pour aller à la section Références, 4Ahmad A.A., Ikram M.A. Plating of an isolated fracture of shaft of ulna under local anaesthesia and periosteal nerve block Trauma Case Rep 2017 ;  12 : [40e44].

Cliquez ici pour aller à la section Références, 5Ahmad A.A., Yi L.M., Ahmad A.R. Plating of distal radius fracture using the wide-awake anesthesia technique J Hand Surg Am 2018 ;  43 (11) : [1045.e1e1045.e5].

Cliquez ici pour aller à la section Références, 6Lalonde D.H. Latest advances in wide awake hand surgery Hand Clin 2019 ;  35 (1) : [1e6].

Cliquez ici pour aller à la section Références, 7Huang Y.C., Chen C.Y., Lin K.C., Yang S.W., Tarng Y.W., Chang W.N. Comparison of wide-awake local anesthesia no tourniquet with general anesthesia with tourniquet for volar plating of distal radius fracture Orthopedics 2019 ;  42 (1) : [e93ee98].

Cliquez ici pour aller à la section Références, 8Huang Y.C., Hsu C.J., Renn J.H., et al. WALANT for distal radius fracture: open reduction with plating xation via wide-awake local anesthesia with no tourniquet J Orthop Surg Res 2018 ;  13 (1) : 195 [cross-ref]

Cliquez ici pour aller à la section Références, 9Ribak S., Folberg C.R., de Oliveira Alves J.A. The Brazilian Perspective of WALANT in fracture fixation from the hand to the elbow J Hand Surg Global Online 2022 ;  4 : [471e476].

Cliquez ici pour aller à la section Références].

The WALANT technique is an easily applied, safe, and efficient anesthetic technique for open reduction and internal fixation of distal radius fractures. It does not require tourniquet so it keeps the patient free from tourniquet pain and complications. It is economical because it doesn’t require for any more expensive preoperative investigations. It does not require sedation, which allows the patients to communicate with the doctors during the procedure and perform active movement of the operated limb to examine if there is an impingement of implants.