Podium (General) 21

Early Outcome of Closed Reduction and Percutaneous Pinning of Phalangeal and Metacarpal Fractures under Wide Awake Local Anesthesia No Tourniquet Done Immediately at the Emergency Room

Jan Patrick R. Hernandez, MD

Introduction: Phalangeal and metacarpal fractures represent   80% of the hand fractures seen at Philippine Orthopedic Center. Percutaneous   pinning with Kirschner wires is a widely accepted option for these fractures.


Objectives: The objective of this study was to evaluate   the early outcome and complications among patients with phalangeal and   metacarpal fractures treated with closed reduction and percutaneous pinning   under WALANT (Wide Awake Local Anesthesia No Tourniquet).


Methodology: This was a prospective case series conducted   at our institution. One hundred fifty-five patients were included and the   following were measured: (1) Disabilities of the Arm, Shoulder, and Hand   (DASH) score, (2) total active motion (TAM), and (3) complications such as   infection and non-union.

Results: Average DASH score after removal of implant   (ROI), 1st, 2nd, and 3rd month after ROI   were 53.1 ±   13.9, 40.11 ± 13.5, 20.3± 7.3, and 7.4 ± 3.9,   respectively. Average TAM taken for   the same period were 210° ±   37.4, 217.9° ± 39.3, 236.33° ±   35.08, and 248.3° ± 34.23, respectively. One patient had an infection and no case of   non-union nor need for conversion to open reduction internal fixation (ORIF)   was monitored.


Conclusion: Immediate closed reduction   and percutaneous pinning under WALANT is a good treatment for stable   phalangeal and metacarpal fractures at the emergency room of the Philippine   Orthopedic Center. Early evaluation revealed positive clinical   outcomes and low complication rates.