Wide-awake local anesthesia No tourniquet (WALANT) for reconstruction of flexor pollicis longus ruptures following volar plate fixation of distal radius fractures- A Case series

Abstract

Background: The flexor pollicis longus tendon rupture following distal radius fractures is a known complication and reconstruction with interposition tendon graft achieved a good outcome. Therefore, this study aims to analyze the outcome of FPL tendon reconstruction using the wide-awake local anesthesia no tourniquet (WALANT) technique. Methods: Seven patients with attritional FPL rupture were retrospectively analyzed between 2014 and 2021. All these patients had FPL reconstruction using palmaris longus interposition graft under WALANT. The patient demographics, Soong volar plate prominence classification, volar plate type, and functional outcome assessment were reviewed. Results: The FPL tendon rupture occurred at a mean of 1.1 years (range, 6 months −3 years) following volar plate fixation. The patients had T-buttress (n ​= ​6) and volar locking plates (n ​= ​1). The mean follow-up of our study was 16.5 months (range 12–19 months). The total interphalangeal joint movement, grip strength, pinch strength, and Kapandji score were significantly less than the uninjured hand (p ​< ​0.05). The mean DASH Score was 14 (range 4.5–28). All surgeries were daycare, and WALANT provided effective analgesia and a comfortable patient experience. Conclusions: FPL reconstruction using WALANT achieves a good functional outcome. In addition, the intraoperative assessment of tendon excursion, adjusting the tension, and educating early rehabilitation are the advantages of the WALANT. Level of evidence: IV, Retrospective case study.

Keywords

• FPL rupture
• Volar plate distal radius fracture
• Palmaris longus graft
• WALANT
• Good outcome