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

Hyatt, Brad T., M.D.; Rhee, Peter Charles, D.O., M.S.

Plastic and Reconstructive Surgery: March 2019 - Volume 143 - Issue 3 - p 800-810
doi: 10.1097/PRS.0000000000005379
Hand/Peripheral Nerve: Original Articles

Summary: 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.

Dayton, Ohio; and Rochester, Minn.

From the Department of Orthopedic Surgery, Wright-Patterson Air Force Base; and the Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic.

Received for publication May 10, 2018; accepted August 27, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article. No funding was received for this article.

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Peter Charles Rhee, D.O., M.S., Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minn. 55905,, Twitter: @petercrhee_do

Copyright © 2019 by the American Society of Plastic Surgeons