Low Infection Rate for Hand Fractures Managed with Surgical Fixation under Wide-Awake Local Anesthesia with No Tourniquet in Minor Surgery.

Autor:	Steve AK; From the Division of Plastic Surgery and Cumming School of Medicine, University of Calgary., Shine JJ; From the Division of Plastic Surgery and Cumming School of Medicine, University of Calgary., Yakaback S; From the Division of Plastic Surgery and Cumming School of Medicine, University of Calgary., Matthews JL; From the Division of Plastic Surgery and Cumming School of Medicine, University of Calgary., Yeung J; From the Division of Plastic Surgery and Cumming School of Medicine, University of Calgary.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2022 Oct 01; Vol. 150 (4), pp. 829-833. Date of Electronic Publication: 2022 Jul 27.
DOI:	10.1097/PRS.0000000000009542
Abstrakt:	Background: The purpose of this study was to review the rate and type of infectious complications after surgical fixation of hand fractures managed under wide-awake local anesthesia with no tourniquet (WALANT) in minor procedure rooms outside the main operating room. Methods: A two-surgeon retrospective chart review was performed of patients who received surgical fixation of hand fractures under WALANT in minor surgery from March of 2014 to March of 2019. Results a Total of: patients, with distal phalanx ( n = 16), middle phalanx ( n = 7), proximal phalanx ( n = 11), or metacarpal ( n = 26) fractures, were included in the study. The average patient age was 37 years, with a higher proportion of male patients (51:7). Two patients had two fractures each. Thirty of the 58 cases were already open fractures. Fixation was performed using either plates and screws (25 of 58) or nonburied Kirschner wires (31 of 58). Thirty-six percent of patients (21 of 58) were treated with prophylactic antibiotics. One patient developed postoperative cellulitis. The only case of osteomyelitis occurred in a patient with risk factors known to increase rates of infectious complications (open fracture, smoking history, and >24 hours from injury to treatment). No infectious complications occurred in those who sustained closed fractures. Conclusions: Although the minor surgery environment varies significantly from that of the main operating room, infection rates after surgical fixation of hand fractures using WALANT in this setting remain low (3.4 percent), with no documented infections in fractures that were referred closed and opened surgically for operative fixation. Clinical Question/level of Evidence: Therapeutic, IV. Competing Interests: Disclosure : The authors have no financial or conflicts of interest to declare in relation to the content of this article. (Copyright © 2022 by the American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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