Ankle Fracture Fixation with Use of WALANT (Wide Awake Local Anesthesia with No Tourniquet) Technique: An Attractive Alternative for the Austere Environment.
Wide awake local anesthesia with no tourniquet (WALANT) is a simple technique that has had successful application in hand surgery. When utilized in the plating of distal radial fractures, the WALANT technique has proven to be a cost-effective approach in orthopaedic trauma. The aim of the present study was to assess the applicability of the WALANT technique in open reduction and internal fixation of ankle fractures.Fifty-eight patients were recruited from October 2016 to September 2018. Fractures were categorized according to the OTA/AO classification. We did not include patients with Maisonneuve, talar, or posterior malleolar fractures. Mechanism of injury, fracture type, comorbidities, and complications were recorded. The surgical site was infiltrated to achieve local anesthesia using a solution of 0.9% normal saline solution and 2% lidocaine with 1:1,000,000 epinephrine. Functional outcomes were assessed at the time of fracture union with use of the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale.Thirty-nine patients (67%) were male and 19 (33%) were female, and the mean age was 46.79 ± 8.54 years. According to the OTA/AO classification, 36 fractures (62%) were 44C2, 11 (19%) were 44B2, 7 (12%) were 44C1, and 4 (7%) were 44B1 fractures. Average blood loss was 29.40 ± 7.38 mL, the mean operative time was 59.72 ± 7.19 minutes, and the mean intraoperative visual analogue scale (VAS) for pain was 1.24 ± 0.43 (range, 0 to 3). The mean time to union was 16.21 ± 3.52 weeks, with a mean AOFAS Ankle-Hindfoot Scale score of 86.38 ± 5.72. Three patients (5.2%) developed nonunion of a fracture site, 2 patients had a surgical site infection, and 1 noncompliant diabetic patient developed osteomyelitis.The WALANT technique is a safe technique for ankle fracture fixation and has been shown to be useful in foot and ankle surgery, particularly in limited-resource environments.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.