Wide-awake local anesthesia no tourniquet (WALANT) technique versus general anesthesia for the removal of implants after ankle fracture union - A randomized controlled trial.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2025;13(20):15 J Foot Ankle Surg . 2025 Jul-Aug;64(4):462-468.What this means for my practice?
For ankle hardware removal after union, WALANT delivers less early pain, less anxiety and nausea, and faster PACU discharge without sacrificing operative time, blood loss, or satisfaction. Clinically, it’s a practical, safe alternative that can streamline throughput and enhance patient experience in appropriately selected patients and experienced hands. Limitations include single-center design, modest sample size, inability to blind, selective eligibility (lateral/medial implants only), and no formal cost analysis—tempering generalizability.
Study Summary
Fifty-six patients with united ankle fractures requiring implant removal were randomized to receive WALANT (n=28) or general anesthesia (n=28). The primary outcome was pain (11-point VAS) measured repeatedly postoperatively. Secondary outcomes included anxiety (VAS), patient satisfaction, blood loss, operating-room and skin-to-skin times, recovery-room time, and adverse events; wounds were followed to 8 weeks and complications to 1 year. Overall, the results showed lower pain at 2 and 6 hours with WALANT, lower postoperative anxiety, markedly shorter recovery-room stays, and less nausea, with no differences in operative efficiency metrics or blood loss. These findings suggest WALANT is a safe, effective alternative to general anesthesia for ankle hardware removal, improving early recovery without compromising surgical conduct.
Unlock the Full ACE Report
You have access to 4 more FREE articles this month.
Click below to unlock and view this ACE Reports
Unlock Now
Critical appraisals of the latest, high-impact randomized controlled trials and systematic reviews in orthopaedics
Access to OrthoEvidence podcast content, including collaborations with the Journal of Bone and Joint Surgery, interviews with internationally recognized surgeons, and roundtable discussions on orthopaedic news and topics
Subscription to The Pulse, a twice-weekly evidence-based newsletter designed to help you make better clinical decisions
Exclusive access to original content articles, including in-house systematic reviews, and articles on health research methods and hot orthopaedic topics
Or upgrade today and gain access to all OrthoEvidencecontent for as little as $1.99 per week.
Already have an account? Log in
Are you affiliated with one of our partner associations?
Click here to gain complimentary access as part your association member benefits!
0 of 4 monthly FREE articles unlocked
