Wide Awake Local Anesthesia No Tourniquet (WALANT) for closed reduction and percutaneous pinning (CRPP) of pediatric hand fractures: A retrospective review

Background and Purpose: The Wide Awake Local Anesthesia No Tourniquet (WALANT) approach for hand surgery offers numerous advantages. However, its use in children and adolescents remains limited. The objective of this study was to evaluate our clinical experience in the surgical management of pediatric hand fractures using WALANT. Methods: A retrospective review was conducted on pediatric patients (<18 years old) who sustained a hand fracture and underwent closed reduction and percutaneous pinning (CRPP) using WALANT. The study included all cases managed by the senior author at a tertiary care center over a 5-year period. Patient demographics, clinical findings, intervention details, pain scores, complications, and functional outcomes were documented. Statistical analyses were performed to identify predictors of pain. Results: A total of 73 patients with 75 hand fractures were included. The mean age at surgery was 13.4 years (range: 5.3-17.4 years). Conversion to general anesthesia/sedation due to intolerance was not required. The mean intra-operative pain score was 2.2/10.0 (range: 0.0-8.0). Those with metacarpal fractures had significantly higher pain scores than those with phalangeal fractures (difference: 2.8). Pain scores were not associated with sex, K-wire quantity, age, or time from injury to surgery. Patients were followed for a mean of 17 weeks (range: 3-82 weeks). Overall, complete function and healing was established in 72 (96.0%) cases. One case each of malunion, articular incongruity and nonunion were observed. Nonetheless, after secondary procedures, satisfactory outcomes were achieved. No other complications were reported. Conclusions: WALANT-based CRPP is an effective, safe and well-tolerated alternative for eligible pediatric hand fractures. These findings support the broader implementation of this technique in children and adolescents.