My Journey to Apply WALANT (Wide Awake Local Anesthesia No Tourniquet) in Distal Radius Fracture and Related Injury

Wide-Awake Local Anesthesia No Tourniquet (WALANT), first introduced over a decade ago, has proven a safe and effective technique and has since gained widespread acceptance for use in various hand surgeries. Traditionally, it has been predominantly applied to soft tissue procedures involving tendons, nerves, fascia, and skin, where its efficacy is well-established.  

However, regarding bony procedures, particularly those involving fractures, there remains some hesitation about whether WALANT can provide adequate anesthesia for any manipulation and implantation of bone. In 2015, I began experimenting with WALANT in the treatment of distal radius fractures despite the skepticism. Over the years, I refined the drug composition, adjusted procedural protocols, and paid close attention to critical intraoperative considerations to improve patient satisfaction and the success of the procedure process. This was conducted to develop a standardized approach that we implemented at Kaohsiung Veterans General Hospital.  

2018, I published our first study on using WALANT in distal radius fractures, marking a significant milestone. Since then, several more papers have emerged detailing different approaches to WALANT in distal radius fractures. Although each method varies slightly, they all contribute valuable insights into the effectiveness of WALANT in bony procedures. Building on this foundation, our team has successfully extended this technique to other kinds of fractures, with positive results. In this presentation, I will take the audience through the journey of how WALANT was adapted for bony surgeries, the challenges faced, and the eventual expansion of its use in fracture management.