ABC TEST

Introduction

PatientsA prospective longitudinal cohort study was performed over five years. Patients over the age of 18 who were treated, either surgically or conservatively, for a lateral compression pelvic ring injury at the University Medical Center Groningen (UMCG)—a level 1 trauma center and referral center for pelvic injuries in the north of the Netherlands—were included.All patients who did not have any known cognitive disorders, nor a previously deformed pelvis or limited mobility, and who were able to communicate in the Dutch language, were informed about the study and asked to participate. Patients who were transferred to a different region to complete their follow-up, or those with a tertiary referral to the UMCG and seen only once at the outpatient clinic, were excluded.Patients were treated according to standard clinical practice. The choice of treatment was based on a combination of clinical presentation, imaging, and the patient’s ability to mobilize (i.e., walk). Treatment decisions were made jointly by the pelvic trauma surgeons and the patient.The local Medical Ethical Review Board reviewed the study methods and waived the need for further approval (METc 2017/543).Data CollectionData on patient characteristics were prospectively collected from electronic medical records and entered into the database at the time of clinical presentation. Collected data included information about the injury, treatment, complications, and mortality.Radiographs were retrieved from electronic patient records and assessed by two trauma surgeons with more than five years of experience in pelvic ring injury surgery. These included plain anteroposterior, inlet, outlet radiographs, and CT scans. Pelvic ring injuries were classified according to the Young-Burgess classification [11].Pain scores, opioid use, and walking ability scores were recorded by surgeons or specialized nurses using an electronic template in the patient’s file. These were collected at hospital admission, 3 days, 1 week, 6 weeks, 3 months, 6 months, 1 year, and 2 years after the injury.Outcome MeasuresPain:Pain perception was assessed at rest and on exertion using the Numeric Rating Scale (NRS) ranging from 0 to 10 [17]. Pain scores were specific to the pelvic area. An NRS score of ≥ 4 at rest was considered indicative of unacceptable pain [18, 19].Opioid Use:Opioid use was recorded as a binary variable (yes or no) at each time point, serving as a proxy for pain severity [20]. Since opioids were prescribed as needed, exact dosages were not consistently available. Non-opioid analgesic use was not recorded due to potential underreporting [21].Walking Ability:Walking ability was assessed on a 0–7 scale, where 0 represented bedridden status and 7 indicated full mobility without walking aids. Patients self-reported their current level of mobility during anamnesis. The mobility scores were grouped into three categories:0–1 = immobile2–4 = mobile with a walking aid5–7 = independently mobileThe walking ability assessment was based on a mobility question from the Majeed Pelvic Outcome Score [22].AnalysisStatistical analysis was performed using SPSS software (version 28, IBM Corp). Descriptive statistics were used to report patient demographics, injury characteristics, and follow-up outcomes.For normally distributed data, means and standard deviations were reported.For non-normally distributed data, medians and interquartile ranges (IQR) were used.To illustrate recovery over time, line graphs were generated showing trends in pain, opioid use, and mobility for patients with LC injuries. A sub-analysis was also performed comparing operatively and non-operatively treated patients, with separate line graphs to visualize the differences.Comparisons between the non-operative and operative groups were made using an independent t-test for continuous variables and a chi-square test for categorical variables. Detailed comparisons are provided in the supplementary data.

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(Fig. 1) image test [15, 16] Concerns regarding the risk of digital necrosis associated with the use of epinephrine in local anesthesia have been mitigated through studies confirming the safety of lidocaine with epinephrine, provided it is administered correctly [7, 8, 9, 10] Considering the limited implementation of WALANT in lower limb surgeries, this study aims to comprehensively evaluate the WALANT technique in comparison to conventional general anesthesia for implant removal post-ankle fracture union. The investigation will extend to assess the technique’s safety, practicality, and clinical outcomes, as well as its impact on operating room efficiency. [7, 8, 9, 10]. [1, 2, 3, 4]

[15, 16] Concerns regarding the risk of digital necrosis associated with the use of epinephrine in local anesthesia have been mitigated through studies confirming the safety of lidocaine with epinephrine, provided it is administered correctly [7, 10] Considering the limited implementation of WALANT in lower limb surgerie[1]s, this study aims to comprehensively evalua(Fig. 1)te the WALANT technique in comparison to conventional general anesthesia for implant removal post-ankle fracture union. The investigation will extend to assess the technique’s safety, practicality, and clinical outcomes, as well as its impact on operating room efficiency. [7 - 10]. [1 - 4]

Ankle fractures 3 w432 4 324 23 423 4 2, with an incidence rate of 4.22 per 10,000 person-years, are a frequent occurrence in orthopedic practice [1] They often necessitate surgical intervention involving internal fixation. Following fracture union, implant removal may be required for reasons ranging from symptomatic relief to patient preference, despite it being a frequent procedure with inherent risks including infection, wound healing complications, and potential neurovascular injuries . The perceived benefits of implant removal are somewhat debatable[]; however, there is evidence suggesting that patients with specific complaints may report symptomatic improvement post-procedure [2] Implant removal is conventionally performed under general or regional anesthesia with the use of a tourniquet to ensure a bloodless surgical field. These methods, while effective, carry their own risks and additional costs[5]. The Wide-Awake, Local Anesthesia, No Tourniquet Technique (WALANT) has emerged as a recent alternative, primarily adopted for hand and wrist surgery. The technique aimed to reduce wait times, increase turnover rates, and provide a bloodless surgical field without the need for general or regional anesthesia [6, 7]. The application of WALANT has expanded beyond minor hand surgeries to include more complex procedures such as open reduction and internal fixation (ORIF) [] Nevertheless, its utilization in lower limb surgeries, particularly for ankle fractures and subsequent implant removal, remains sparse, with only a handful of studies exploring its potential benefits and safety in these contexts. The technique has been well-received thus far, demonstrating minimal adverse effects and high levels of satisfaction from both patients and surgeons [9, 13, 14]. The use of local anesthesia with lidocaine and epinephrine in WALANT not only provides anesthesia but also ensures vasoconstriction, eliminating the need for a tourniquet and reducing the potential for associated complications [15, 16] Concerns regarding the risk of digital necrosis associated with the use of epinephrine in local anesthesia have been mitigated through studies confirming the safety of lidocaine with epinephrine, provided it is administered correctly [7, 8, 9, 10] Considering the limited implementation of WALANT in lower limb surgeries, this study aims to comprehensively evaluate the WALANT technique in comparison to conventional general anesthesia for implant removal post-ankle fracture union. The investigation will extend to assess the technique’s safety, practicality, and clinical outcomes, as well as its impact on operating room efficiency. [7, 8, 9, 10]. [1, 2, 3, 4]New references range testing [1 - 4]. I have written 1-4 in brackets. [1]

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