gms | German Medical Science

Objectives/Interrogation: Wide-awake local anesthesia using no tourniquet (WALANT) hand surgery is a still gaining popularity. WALANT has been used by hand surgeons when operating on skin, nerve entrapments, tendons and bones. The limits of hand surgery under local anesthesia are permanently being pushed further.

We report a proximal row resection performed under local anesthesia in WALANT: The 57 years old patient underwent multiple surgery for "trapeziometacarpal arthrosis". Due to the persistent pain, her general practitioner organized a consultation in our tertiary center. During clinical evaluation, she indicated the center of the wrist as "source of pain". Flexion and extension of the wrist was very painful. The power grip was 11 kg at the examined hand versus 28 kg on the contralateral hand. The radiographs show a lunocapitate joint arthritis. The patient is not willing to undergo four-corner fusion or wrist arthrodesis therefore we propose a proximal row carpectomy in WALANT.

Methods: We injected 8 ml Lidocain 2% with ephedrin and 10% natrium bicarbonats around the wrist and 2 ml intra-articulair.

After transvers skinincision and a radial based capsular flap we extirpated bones radial and ulnar to the common digital extensor with help of a burr.

Results and Conclusions: Perioperative painscore was VAS 0.

We offer technical insights on how to perform this procedure as well as the main advantages, which are associated with using WALANT proximal row carpectomy.