sodium-bicarbonate and Fractures--Bone

Fixation of clavicle fractures has now become a more popular option as it provides better outcome compared with conservative management. Wide-awake local anesthesia no tourniquet (WALANT) has been effectively used in plating of distal radius and olecranon fractures. This paper expands the usage of WALANT into the shoulder girdle, namely plating of the clavicle that has not been described. The operation is typically performed under general anesthesia.. We report a case series of 16 patients who successfully underwent fixation of the clavicle under the wide-awake technique. The clavicle fractures were grouped under the AO Fracture Classification. The WALANT solution comprised 1% lidocaine, 1:100,000 epinephrine, and 10:1 sodium bicarbonate. A total of 40 mL was injected in each patient with 10 mL subcutaneously along the clavicle followed by 30 mL subperiosteally at multiple intervals and directions.. The Numerical Pain Rating Score was 0 during WALANT injection and during surgery except for 2 patients with Numerical Pain Rating Scores of 1 and 2, respectively, during reduction.. We conclude that clavicle plating under WALANT is a good alternative option of anesthesia.

Topics: Adolescent; Adult; Anesthesia, Local; Anesthetics, Local; Bone Plates; Buffers; Clavicle; Epinephrine; Female; Fracture Fixation, Internal; Fractures, Bone; Humans; Injections; Lidocaine; Male; Middle Aged; Pain; Pain Measurement; Sodium Bicarbonate; Vasoconstrictor Agents; Young Adult

We describe a case of a 59-year-old woman with a medical history of upper leg pain and chronic lymphatic leucaemia (CLL), with known diffuse bone marrow infiltration and without signs of lymphatic or extra-lymphatic disease activity on positron emission tomography CT (PET-CT). She presented with multiple fractures of the pelvis, sacrum and left proximal femur as a result of a low energy fall. During admission, she sustained a non-traumatic fracture of the right proximal femur. Pathological fractures in patients with CLL are usually based on Richter's transformation or multiple myeloma. However, in the current case, a PET-CT and a bone marrow biopsy showed no signs of this. We did see a normoparathyroid hypercalcaemia in our patient, most likely caused by a CLL-based release of local osteoclast stimulating factors. A combination of fludarabine/cyclofosfamide/rituximab was started as treatment in combination with allopurinol and sodium bicarbonate to prevent further osteolysis.

Topics: Accidental Falls; Allopurinol; Antineoplastic Agents; Bone Marrow; Female; Femur; Fractures, Bone; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Middle Aged; Osteolysis; Pelvis; Positron-Emission Tomography; Radiography; Rituximab; Sacrum; Sodium Bicarbonate; Treatment Outcome; Vidarabine