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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Patella Fracture Fixation Via Wide Awake Local Anesthesia No Tourniquet (Walant) Technique
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Patella Fracture Fixation Via Wide Awake Local Anesthesia No Tourniquet (Walant) Technique

机译：髌骨骨折固定通过宽阔的清醒局部麻醉无止血带（瓦尔娃娃）技术

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Introduction: Fractures of the patella constitute an estimated 1% of all acute orthopaedic fractures. The fracture fixation is usually performed under general or spinal anesthesia with tourniquet use. We describe a novel approach of anaesthesia for patella fracture fixation using the WALANT technique. Methods: We presented a case of 22 years old male with right knee pain following a road traffic accident. Examination revealed tenderness on his right knee with extensor mechanism failure, and radiograph showed comminuted 3 parts patella fracture, requiring fixation. Adequate information regarding WALANT was given and he agreed. Results: Open reduction and internal fixation were done using tension band wiring (TBW) technique and screw fixation. WALANT mixture was given 30 minutes prior to skin incision. Visual analog score (VAS) was 0 throughout the surgery. He was able to do active range of movement (ROM) of the knee intraoperatively after the fixation. Discussion: The solution used was mixture of 50ml lignocaine 2% (for local anesthesia), 1ml of adrenaline 0.18% (for hemostasis), 10ml of sodium bicarbonate 8.4% (to buffer the solution) and diluted with 50ml normal saline for tumescent anesthesia effect. Safe dosage of lignocaine with adrenaline is 7mg/kg. 10ml of mixture injected subcutaneously over mid-axial longitudinal incision site and 30 ml of mixture injected at patella borders and fracture site subperiosteally. We waited 30 minutes to allow adrenaline to reach maximal vasoconstriction and provide dry operative field. Without usage of tourniquet, we avoid complications such as hematoma and post operation swelling. WALANT also permits active motion of knee intraoperatively, which is particularly helpful in post TBW patella patient. Figure 1 : Intraoperative view Figure 2 : Intraoperative view Figure 3 : Xrays post fixation Figure 4 : Xrays post fixation Conclusion: WALANT is a safe option for patients undergoing patella fracture fixation. It gave a painless surgical experience to the patient and offer another option for high risk patients for general / spinal anaesthesia. References: Lalonde D. Wide Awake Hand Surgey (2016): pg 3-32
机译：简介：髌骨的骨折构成估计所有急性整形外科骨折的1％。骨折固定通常是在一般或脊柱麻醉下进行止血带使用。我们描述了使用WALANT技术的髌骨断裂固定的一种新颖的麻醉方法。方法：我们提出了22岁男性的案例，在道路交通事故后右膝关节疼痛。检查延长机制失败的右膝关节的检查显示，X型射线照片显示出粉碎的3份髌骨骨折，需要固定。有关Walant的充分资料，他同意了。结果：采用张力带布线（TBW）技术和螺钉固定进行开放式和内部固定。在皮肤切口之前30分钟给出瓦尔糖混合物。视觉模拟分数（VAS）在整个手术中为0。在固定后，他能够在术后积极的运动范围（ROM）膝关节的运动范围。讨论：使用的溶液是50ml limbocaine 2％（对于局部麻醉）的混合物，1ml肾上腺素0.18％（用于止血），10ml碳酸氢钠8.4％（缓冲溶液），并用50ml生理盐水稀释，用于肿胀麻醉效应。用肾上腺素的Lignocaine安全剂量为7mg / kg。将10ml混合物皮下注射在中轴纵向切口位点，并在髌骨边界和骨折位点注射30ml混合物。我们等了30分钟允许肾上腺素达到最大的血管收缩，并提供干燥的操作场。没有止血带的使用，我们避免了血肿和术后肿胀等并发症。 Walant还允许朝向膝关节的主动运动，这在TBW髌骨后患者特别有用。图1：术中视图图2：术中视图图3：XRAYS柱固定图4：XRAYS柱固定结论：WALANT是接受髌骨骨折固定患者的安全选择。它对患者提供了无痛的手术经验，为一般/脊髓麻醉的高风险患者提供了另一种选择。参考文献：Lalonde D.宽阔的唤醒手静电（2016）：PG 3-32

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