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Introduction
Ankle fractures, with an incidence rate of 4.22 per 10,000 person-years, are a frequent occurrence in orthopedic practice [1] They often necessitate surgical intervention involving internal fixation. Following fracture union, implant removal may be required for reasons ranging from symptomatic relief to patient preference, despite it being a frequent procedure with inherent risks including infection, wound healing complications, and potential neurovascular injuries . The perceived benefits of implant removal are somewhat debatable[]; however, there is evidence suggesting that patients with specific complaints may report symptomatic improvement post-procedure [2] Implant removal is conventionally performed under general or regional anesthesia with the use of a tourniquet to ensure a bloodless surgical field. These methods, while effective, carry their own risks and additional costs[5]. The Wide-Awake, Local Anesthesia, No Tourniquet Technique (WALANT) has emerged as a recent alternative, primarily adopted for hand and wrist surgery. The technique aimed to reduce wait times, increase turnover rates, and provide a bloodless surgical field without the need for general or regional anesthesia [6, 7]. The application of WALANT has expanded beyond minor hand surgeries to include more complex procedures such as open reduction and internal fixation (ORIF) [] Nevertheless, its utilization in lower limb surgeries, particularly for ankle fractures and subsequent implant removal, remains sparse, with only a handful of studies exploring its potential benefits and safety in these contexts. The technique has been well-received thus far, demonstrating minimal adverse effects and high levels of satisfaction from both patients and surgeons [9, 13, 14]. The use of local anesthesia with lidocaine and epinephrine in WALANT not only provides anesthesia but also ensures vasoconstriction, eliminating the need for a tourniquet and reducing the potential for associated complications [15, 16] Concerns regarding the risk of digital necrosis associated with the use of epinephrine in local anesthesia have been mitigated through studies confirming the safety of lidocaine with epinephrine, provided it is administered correctly [7, 8, 9, 10] Considering the limited implementation of WALANT in lower limb surgeries, this study aims to comprehensively evaluate the WALANT technique in comparison to conventional general anesthesia for implant removal post-ankle fracture union. The investigation will extend to assess the technique’s safety, practicality, and clinical outcomes, as well as its impact on operating room efficiency. [7, 8, 9, 10]. [1, 2, 3, 4]New references range testing [1 - 4]. I have written 1-4 in brackets. [1]
(Fig. 1) image test [15, 16] Concerns regarding the risk of digital necrosis associated with the use of epinephrine in local anesthesia have been mitigated through studies confirming the safety of lidocaine with epinephrine, provided it is administered correctly [7, 8, 9, 10] Considering the limited implementation of WALANT in lower limb surgeries, this study aims to comprehensively evaluate the WALANT technique in comparison to conventional general anesthesia for implant removal post-ankle fracture union. The investigation will extend to assess the technique’s safety, practicality, and clinical outcomes, as well as its impact on operating room efficiency. [7, 8, 9, 10]. [1, 2, 3, 4]
[15, 16] Concerns regarding the risk of digital necrosis associated with the use of epinephrine in local anesthesia have been mitigated through studies confirming the safety of lidocaine with epinephrine, provided it is administered correctly [7, 10] Considering the limited implementation of WALANT in lower limb surgerie[1]s, this study aims to comprehensively evalua(Fig. 1)te the WALANT technique in comparison to conventional general anesthesia for implant removal post-ankle fracture union. The investigation will extend to assess the technique’s safety, practicality, and clinical outcomes, as well as its impact on operating room efficiency. [7 - 10]. [1 - 4]
About this article
Received
Tuesday, March 18, 2025
DOI
https://pantheonacademic.com/article/20