Open reduction internal fixation in patella fracture using wide awake local anesthesia no tourniquet technique (WALANT) - A case series

Background: Wide Awake Local Anesthesia No Tourniquet (WALANT) has been accepted safe and effective anesthesia technique for many orthopaedics procedures. Despite growing number of studies, few had described using WALANT in lower extremities with more complexity like the knee. We present a case series of patella fracture fixation using WALANT. Methods: WALANT was used as a method of anesthesia for five patients diagnosed with patella fracture undergone tension band wiring fixation at Thammasat University hospital during 2021 - 2022. Visual analog scale (VAS) was collected throughout the surgery as primary objective and up to 48 h after the operation. We also evaluated their demographic and clinical data, range of motion, total operative time, amount of WALANT used, blood loss and hospital stay. Results: Throughout the procedure, all patients reported no pain or discomfort except at wiring step which average VAS was 2.4 +/- 1.14. The mean total operative time was 91.6 +/- 18.58 min and mean WALANT solution used was 124 +/- 12.94 ml. The visualization of surgical field was satisfying with minimal blood loss. All patients were able to walk with weight-bearing as tolerated right after the operation and were discharged in the same day except one due to lack of caregivers at home. Neither local nor systemic complications were found. No conversion to other anesthesia techniques due to failure of WALANT. Conclusions: This study shows WALANT may be considered safe and effective as an alternative anesthesia technique for patella fracture fixation in ambulatory setting, offering favorable outcome without need for postoperative hospitalization.