{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:38:53Z","timestamp":1787755133375,"version":"build-2784847793"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,9,16]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The use of wide-awake, local-anesthetic, no-tourniquet (WALANT) surgical techniques is increasingly common, and patients commonly ask whether they may drive home following these procedures. The impact of a numb hand and bulky dressing on driving fitness is unknown, and there is no literature to guide surgeons when counseling these patients. Thus, the primary objective of the present study was to determine driving fitness following a modeled-WALANT procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Twelve right-handed individuals (6 male and 6 female) with an average age of 50 years (range, 38 to 64 years) were enrolled. An instrumented vehicle was used to obtain driving kinematic and behavioral data, thus allowing for a multidimensional assessment of driving fitness. Participants first performed a drive to establish baseline kinematic metrics. The route included both public streets and a closed course. Several driving tasks were assessed, including reverse parking, parallel parking, and perpendicular parking. The total course length was 18 miles (29 kilometers) and took 45 to 55 minutes to complete. After the first drive, 10 mL of 1% lidocaine was injected in the volar aspect of the right wrist and another 10 mL was injected into the right carpal tunnel to model the anesthetic used for a WALANT carpal tunnel release, and a bulky soft dressing was applied. The modeled-WALANT drive included an identical route and tasks, in addition to a surprise event to evaluate emergency responsiveness. Driving metrics were analyzed for noninferiority of the modeled-WALANT state to baseline driving.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The modeled-WALANT state showed noninferiority to baseline driving on all 11 analyzed dimensions of driving behavior compared with the control drives. In the modeled-WALANT state, participants drove more conservatively, braked harder, and steered more smoothly. All participants safely performed the 3 parking tasks and emergency response maneuver. Driving fitness in the modeled-WALANT state was noninferior to driving fitness in the preoperative drive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A modeled-WALANT state has no clinically relevant negative impact on driving fitness, and thus surgeons should not discourage patients from driving home after unilateral WALANT surgical hand procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.19.01281","type":"journal-article","created":{"date-parts":[[2020,8,26]],"date-time":"2020-08-26T16:01:05Z","timestamp":1598457665000},"page":"1616-1622","source":"Crossref","is-referenced-by-count":10,"title":["Modeled Wide-Awake, Local-Anesthetic, No-Tourniquet Surgical Procedures Do Not Impair Driving Fitness"],"prefix":"10.2106","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4555-8668","authenticated-orcid":false,"given":"Noah J.","family":"Thompson Orfield","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3431-8167","authenticated-orcid":false,"given":"Ariel E.","family":"Badger","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0527-919X","authenticated-orcid":false,"given":"Allison N.","family":"Tegge","sequence":"additional","affiliation":[{"name":"Virginia Tech Carilion School of Medicine, Roanoke, Virginia"},{"name":"Departments of Statistics (A.N.T.) and Biomedical Engineering and Mechanics (M.A.P.), Virginia Tech, Blacksburg, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9958-113X","authenticated-orcid":false,"given":"Maryam","family":"Davoodi","sequence":"additional","affiliation":[{"name":"Virginia Tech Transportation Institute, Blacksburg, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0437-5603","authenticated-orcid":false,"given":"Miguel A.","family":"Perez","sequence":"additional","affiliation":[{"name":"Departments of Statistics (A.N.T.) and Biomedical Engineering and Mechanics (M.A.P.), Virginia Tech, Blacksburg, Virginia"},{"name":"Virginia Tech Transportation Institute, Blacksburg, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5428-2125","authenticated-orcid":false,"given":"Peter J.","family":"Apel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Carilion Clinic, Roanoke, Virginia"},{"name":"Virginia Tech Carilion School of Medicine, Roanoke, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,6,15]]},"reference":[{"issue":"4","key":"bib1-20230810","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1016\/j.bjps.2004.02.002","article-title":"Upper limb splints and the right to drive\u2014who decides?","volume":"57","author":"Hobman","year":"2004","journal-title":"Br J Plast Surg."},{"issue":"6","key":"bib2-20230810","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.1016\/j.arthro.2018.04.007","article-title":"Return to driving after arthroscopic and related surgery: before patients start, how do we know they can stop?","volume":"34","author":"Rossi","year":"2018","journal-title":"Arthroscopy."},{"issue":"1","key":"bib3-20230810","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0020-1383(00)00153-4","article-title":"Safety to drive after common limb fractures","volume":"33","author":"Rees","year":"2002","journal-title":"Injury."},{"issue":"10","key":"bib4-20230810","first-page":"484","article-title":"When do we think it is safe to drive after hand surgery? - current practice and legal perspective","volume":"109","author":"Murphy","year":"2016","journal-title":"Ir Med J."},{"issue":"12","key":"bib5-20230810","doi-asserted-by":"crossref","first-page":"2557","DOI":"10.1007\/s11999-016-5007-9","article-title":"When can I drive after orthopaedic surgery? A systematic review","volume":"474","author":"DiSilvestro","year":"2016","journal-title":"Clin Orthop Relat Res."},{"issue":"14","key":"bib6-20230810","doi-asserted-by":"crossref","first-page":"e641","DOI":"10.5435\/JAAOS-D-18-00435","article-title":"Upper extremity immobilization and driving: limitations and liability","volume":"27","author":"Chong","year":"2019","journal-title":"J Am Acad Orthop Surg."},{"issue":"1","key":"bib7-20230810","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/S0020-1383(01)00141-3","article-title":"Doctor, can I drive with this plaster? An evidence based response","volume":"33","author":"Blair","year":"2002","journal-title":"Injury."},{"issue":"3","key":"bib8-20230810","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1177\/1753193412451385","article-title":"An objective assessment of safety to drive in an upper limb cast","volume":"38","author":"Stevenson","year":"2013","journal-title":"J Hand Surg EurVol."},{"issue":"13","key":"bib9-20230810","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.2106\/JBJS.I.01170","article-title":"Driving with an arm immobilized in a splint: a randomized higher-order crossover trial","volume":"92","author":"Chong","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib10-20230810","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/J.JHSB.2005.06.018","article-title":"Return to functional hand use and work following open carpal tunnel surgery","volume":"30","author":"Acharya","year":"2005","journal-title":"J Hand Surg Br."},{"issue":"9","key":"bib11-20230810","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1016\/j.jhsa.2017.05.030","article-title":"Safe return to driving after volar plating of distal radius fractures","volume":"42","author":"Jones","year":"2017","journal-title":"J Hand Surg Am."},{"issue":"12","key":"bib12-20230810","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.2106\/JBJS.H.00431","article-title":"Driving after musculoskeletal injury. Addressing patient and surgeon concerns in an urban orthopaedic practice","volume":"90","author":"Chen","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"9","key":"bib13-20230810","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1177\/1753193417728427","article-title":"Conceptual origins, current practice, and views of wide awake hand surgery","volume":"42","author":"Lalonde","year":"2017","journal-title":"J Hand Surg EurVol."},{"issue":"3","key":"bib14-20230810","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/j.injury.2008.06.029","article-title":"Effects of upper-limb immobilisation on driving safety","volume":"40","author":"Gregory","year":"2009","journal-title":"Injury."},{"issue":"3","key":"bib15-20230810","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1177\/230949901502300314","article-title":"Driving with a short arm cast in a simulator","volume":"23","author":"Mansour","year":"2015","journal-title":"J Orthop Surg (Hong Kong)."},{"issue":"2","key":"bib16-20230810","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.jse.2014.06.046","article-title":"The effect of shoulder immobilization on driving performance","volume":"24","author":"Hasan","year":"2015","journal-title":"J Shoulder Elbow Surg."},{"issue":"1","key":"bib17-20230810","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.arth.2017.08.012","article-title":"Braking time following total knee arthroplasty: a systematic review","volume":"33","author":"Hartman","year":"2018","journal-title":"J Arthroplasty."},{"issue":"12","key":"bib18-20230810","doi-asserted-by":"crossref","first-page":"2231","DOI":"10.1016\/j.arthro.2017.08.245","article-title":"Brake reaction time after ankle and subtalar arthroscopy","volume":"33","author":"Sittapairoj","year":"2017","journal-title":"Arthroscopy."},{"issue":"5","key":"bib19-20230810","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.arthro.2016.11.020","article-title":"Brake reaction time after hip arthroscopy for femoroacetabular impingement and labral tear","volume":"33","author":"Vera","year":"2017","journal-title":"Arthroscopy."},{"issue":"5","key":"bib20-20230810","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.knee.2018.07.002","article-title":"Brake response time after modern total knee arthroplasty: how soon can patients drive?","volume":"25","author":"Davis","year":"2018","journal-title":"Knee."},{"issue":"6","key":"bib21-20230810","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1111\/j.1445-2197.2006.03762.x","article-title":"Driving plastered: who does it, is it safe and what to tell patients","volume":"76","author":"Kalamaras","year":"2006","journal-title":"ANZ J Surg."},{"issue":"6","key":"bib22-20230810","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1136\/emj.2008.062943","article-title":"Driving with a forearm plaster cast: patients\u2019 perspective","volume":"26","author":"Edwards","year":"2009","journal-title":"Emerg Med J."},{"issue":"2","key":"bib24-20230810","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.injury.2016.12.024","article-title":"The effects of below-elbow immobilization on driving performance","volume":"48","author":"Jones","year":"2017","journal-title":"Injury."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.01281","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:38:08Z","timestamp":1787751488000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.19.01281"}},"subtitle":["An Experimental On-Road Noninferiority Study"],"short-title":[],"issued":{"date-parts":[[2020,6,15]]},"references-count":23,"journal-issue":{"issue":"18","published-print":{"date-parts":[[2020]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.19.01281","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,15]]}}}