Wide-Awake Approach for Terrible Triad Injury Fixation: A Report of Two Cases

The wide-awake local anesthesia no tourniquet (WALANT) technique has been widely used for various upper extremity surgeries, but its use for surgical fixation of terrible triad injuries has yet to be reported in the literature. Two cases of terrible triad injuries surgically treated under WALANT are presented. Coronoid screw fixation and radial head replacement were performed for the first case, and radial head fixation and coronoid suture lasso were performed for the second. Intraoperative stability during the active range of motion of both the elbows was tested after fixation. Difficulties encountered included pain near the coronoid due to its deep location causing difficulty injecting local anesthetic, and shoulder pain during the surgery due to prolonged preoperative immobilization. WALANT for terrible triad fixation is a viable alternative to general and regional anesthesia in a select number of patients with the added benefit of intraoperative elbow stability testing during active range of motion.