WALANT Experience From VGHTPE: From Distal Radius to Clavicle Fracture

Background: Plating of clavicle fracture has become a more favorable treatment option since it offers better functional outcome and less likelihood of malunion or nonunion. While volar plating of distal radius under wide-awake local anesthesia (WALA) became popular in clinical practice, we also found that plating of clavicle fractured under WALA had been reported, yet it lacked comparison with that under traditional general anesthesia. 

Perspective: The purpose of this study was to compare the clinical outcome between WALA and general anesthesia for plating of mid-third clavicle fracture. 

Methods: A retrospective study was conducted on 61 patients with mid-third clavicle treated by surgical plating at the senior author’s hospital from January 2020 to December 2020, and the patient cohort was divided as group wide-awake local anesthesia (WALA; n=21) and group general anesthesia (GA; n=40). We recorded patient demographic data and clinical result for following comparison between group WALA and group GA. 

Results: The median age of the patient in group WALA was 52 (23.5) years old while group GA was 53 (40.3) years old. The median surgical time in group WALA was 74.0 (13.5) minutes and group GA was 64.5 (12.0) minutes (p<0.05). The median time to bone healing was 12 (2.0) weeks in group WALA and 12 (2.0) weeks in group GA. The median DASH score at final follow-up was 3.3 (2.5) in group WALA and 3.75 (1.7) in group GA. For comparison of post-operative pain degree and total requested morphine dosage, there was no statistical difference between the group at any follow-up. However, the differences were found in pain degree at post-operative day 1/week 1 and total requested morphine dosage if the patients were limited to concomitant rib fracture. 

Conclusion: Wide-awake local anesthesia for surgical plating of mid-shaft clavicle fracture provides non-inferior clinical results as general anesthesia in terms of bone healing and functional outcome.