Wide-Awake Surgical Management of Hand Fractures: Technical Pearls and Advanced Rehabilitation

Plastic and Reconstructive Surgery
Brad T Hyatt, Peter Charles Rhee

Abstract

Most unstable metacarpal and phalangeal fractures for which operative treatment is indicated can be reduced and stabilized with either open or closed techniques using local anesthetic with epinephrine instead of intravenous sedation or general anesthesia. With the patient wide-awake during surgery, the hand can be taken through active range of motion to assess fracture stability. In this article, the authors review the rationale and technique for wide-awake, local anesthesia, no tourniquet surgery in the treatment of phalangeal and metacarpal fractures and impart pearls to optimize the patient experience and illustrate common fixation techniques using percutaneous Kirschner wires. The intraoperative assessment of fracture stability permits an accelerated, protected-range-of-motion protocol that minimizes postoperative stiffness and facilitates expedient recovery.

References

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Jul 6, 2014·Clinics in Plastic Surgery·Shu Guo Xing, Jin Bo Tang
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Citations

Jun 17, 2020·The Journal of Hand Surgery, European Volume·Michel E H Boeckstyns
Apr 24, 2021·Plastic and Reconstructive Surgery·Nishant Ganesh Kumar, Kevin C Chung
Jul 15, 2021·The Journal of Hand Surgery, European Volume·Donald LalondeSteven Koehler
Jul 20, 2021·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·Galip Gencay ÜstünUğur Koçer

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