Ostéosynthèse des fractures du radius distal en mini-open et en WALANT par plaque verrouillée antérieure

Abstract

The aim of this comparative and prospective study was to evaluate the feasibility and benefits of a mini invasive pronator-sparing technique for radius distal fracture treated with volar locking plate performed with a WALANT anesthesia. Sixty patients (from June 2016–June 2017) with an extra articular fracture of the distal radius and a mean age of sixty two years were managed with a distal volar plate and an in situ catheter for continuous diffusion of Ropivacaine during 48 hours after surgery. There were two groups (30 patients per group). Patients of the first group receive a WALANT anesthesia (Lidocaine 1%, epinephrine 0.05/10 ml). In the second group patients have had an ultrasound guided axillary block and a tourniquet. The following points were monitored: duration of the procedure, need for additional anesthesia or sedation during the surgery, patient discomfort. Pain was evaluated with a visual analog scale at Day 0, Day 1, Day 2, Day 3, Day 7, and Day 45. A clinical and radiological evaluation was made at 6 weeks and 3 months after surgery (range of motion, anatomical alignment and screw placement). The study was approved by our local ethics committee. All the patients were available at the last follow up. In the group I (WALANT) VAS (D0/D1/D2) was significantly lower than in the group II (2.2/3.5/4.9 vs 4.1/4.8/6.2). The were no difference of the results of VAS after Day 2. In the group I no patients received a sedation, while in group II 4 patients required additional analgesia. During the procedure, and only in group II, 2 patients complained about pain at the wrist, 12 of discomfort at the tourniquet and 8 patients were anxious about not knowing where their arms were located. At the last follow up there was no significant difference between the two groups for the duration of the procedure, range of motion and for the anatomical alignment. A reflex sympathetic dystrophy syndrome occurred for 3 patients of the second group. The use of WALANT for open reduction and internal fixation of distal radius fractures allows clinical and anatomical results identical to those obtained with conventional techniques. Moreover, WALANT seems to be a powerful tool for risk management of reflex sympathetic dystrophy syndrome.