Abstract
Avulsion fracture of medial epicondyle fractures accounted for 30.77% of elbow fractures. Fixation is needed when the fragment displaced significantly. These cases were usually done under general anaesthesia / regional anaesthesia. We describe a novel technique of using WALANT to proceed with this surgery.
Methods:
A combination of lignocaine, 1:100000 epinephrine and 10:1 sodium bicarbonate with a safe limit of 7mg/kg for lignocaine and epinephrine is used. The operation was done with continuous visual analog score and vital signs monitoring until postoperatively. Range of motion and blood loss was monitored post fixation intraoperatively. In every patients who undergo an operation under WALANT technique, we will provide , IV Dynastat 40mg BD x 1/7, T Celebrex 200mg BD and T PCM 1g PRN x 1/52.
Discussion:
The limitation faced during the procedure is that, the local anaesthesia cannot reach the second cortex of the humerus. The problem arises when the drill bit touches the second cortex of the bone which will cause pain to the patient. To remedy this, we injected 5ml of the solution to the expected trajectory of the screw at the far cortex. However, the procedure does not need to go through second cortex of the bone, so this limitation is manageable.
Results:
Patient’s pain score remain 0-2 after administration of solution, throughout the surgery and postoperatively. Estimated blood loss was 80cc and range of motion was full post fixation intraoperatively.
Conclusion:
Screw fix medial epicondyle under WALANT is a good alternative for patients with multiple comorbids and high risk for surgery to be done under general anaesthesia. Patient remain comfortable throughout the procedure and post operatively. Range of motion can be assessed post fixation intaraoperatively thus allow light exercise post operatively which is good to prevent elbow stiffness.
References:
Ahmad AA., Yi LM., Ahmad AR Plating of Distal Radius Fracture Using the Wide-Awake Anesthesia Technique. Journal of Hand Surgery. (2018) 43 (11) , pp 1045. el- 1045.e5 -1045.e5