gms | German Medical Science

Objectives/Interrogation: TO verify that open reduction and internal fixation of distal radius fractures is feasible, financially beneficial and safe for the patients

Methods: We present four cases that we performed using wide awake local anaesthesia no tourniqet in two countries (UK and Cyprus). We also present our injection technique.

UK patients were operated as part of the NHS which offers universal free-for-all healthcare and patients in Cyprus were operated in a private healthcare setting with patients paying for their care from their budget.

In Cyprus, patients that receive their surgery wide awake, had the injection of the LA in the office, walked to theatre to receive their procedures and then were discharged immediately from theatre with no stay in a day case ward.

In the UK, patients received their LA injections in the ward, had their procedure in the clean air theatre and then discharged from the day case ward.

Results: Of the four patients the three had the procedure with no problem, tolerating it very well. Of the three, one of the patients had to have her distal radius osteotomised as three and a half weeks passed from the day of injury, tolerating it with no problems. For all patients, either the Medartis Aptus Adaptive of the Medartis FPL plate were used.

One of the patients expressed discomfort during surgery, but surgery was concluded without any further problems and without any sedation. No tourniquet was used.

All four patients went on to have their fractures healed and recovered a complete range of motion. No one developed any kind of infection or wound healing problems and returned to their pre-injury activities or occupations.

Financial benefits for self-paying patients were in the range of 1000 euros, as this amount included the fees of the anaesthetist, the day case bed, the intraoperative medication as well as the increased stay in recovery.

In the NHS, the possibility to carry on with surgery without an anesthetist and the increased turn around time led to increased theatre utilization.

Conclusion: The WALANT approach for the open reduction and internal fixation of distal radius fractures is a feasible and safe alternative to other methods of anaesthesia that can be utilised in developing countries with no universal healthcare as well as in overcrowded healthcare systems to maximise theatre and staff utilization.