{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:40:41Z","timestamp":1760060441037,"version":"build-2065373602"},"reference-count":38,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:00:00Z","timestamp":1756339200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Femoral neck and proximal femur fractures in the elderly can result from low-energy trauma due to osteoporotic changes and contribute significantly to increased morbidity and mortality. Despite various treatment options, closed reduction and internal fixation (CRIF) with intramedullary nails has become the predominant approach. While a minimally invasive approach reduces complications and speeds recovery, this outcome is not always feasible in practice. The primary surgical goal remains achieving a stable and precise fracture reduction, favoring CRIF when possible. Our study aims to evaluate the clinical, radiological, and functional outcomes of patients operated on using the Wide-Awake Local Anesthesia No Tourniquet (WALANT) technique. Methods: Patients who underwent surgery for intertrochanteric femur fractures between June 2019 and June 2021 were analyzed. Patients who were between 75 and 90 years old and had undergone surgery with a proximal femoral nail (PFN) were included in the study. Patients were excluded if they required general anesthesia, if an acceptable reduction could not be achieved with the PFN, if they did not attend the last follow-up examination, or if the follow-up period was &lt;4 years. Patients were functionally assessed using the Harris hip score at the 6th month and at the last follow-up and using the visual analog scale at the surgery, at the 4th hour after surgery, and at the time of discharge. For radiological assessment, the classification of reduction quality and the measurement of the tip\u2013apex distance were used. Results: Forty patients (22F\/18M) were included in the study. Their mean age was 83.0 \u00b1 2.9 years. The mean time from trauma to surgery was 6.8 \u00b1 2.3 h. Patients were mobilized on average 1.53 \u00b1 0.8 h after surgery, and the mean hospitalization time was 27.4 \u00b1 8.1 h. No statistically significant decrease in hemoglobin value was observed before or after surgery (p = 0.476). The Harris hip score was 73.3 \u00b1 3.2 at the 6th month postoperatively and 74.9 \u00b1 2.5 at the last follow-up (p = 0.296). The reduction quality was found to be poor in only two patients. Conclusions: The WALANT technique\u2019s promising results in terms of pain management, blood loss control, and early mobilization show that it is a viable alternative to conventional anesthesia methods in geriatric hip fractures.<\/jats:p>","DOI":"10.3390\/jcm14176078","type":"journal-article","created":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:29:18Z","timestamp":1756376958000},"page":"6078","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigation of the Medium- and Long-Term Results of a Pioneering Method in the Treatment of Geriatric Intertrochanteric Femur Fractures: Osteosynthesis Using the WALANT Technique"],"prefix":"10.3390","volume":"14","author":[{"given":"Yusuf Murat","family":"Altun","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Traumatology, School of Medicine, Bilecik \u015eeyh Edebali University, 11230 Bilecik, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3782-5535","authenticated-orcid":false,"given":"Mete","family":"Gedikba\u015f","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, School of Medicine, Bilecik \u015eeyh Edebali University, 11230 Bilecik, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8495-3161","authenticated-orcid":false,"given":"Murat","family":"A\u015f\u00e7\u0131","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, School of Medicine, Bilecik \u015eeyh Edebali University, 11230 Bilecik, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1001\/jamainternmed.2018.0743","article-title":"Association of Clinical Outcomes with Surgical Repair of Hip Fracture vs Nonsurgical Management in Nursing Home Residents with Advanced Dementia","volume":"178","author":"Berry","year":"2018","journal-title":"JAMA Intern. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e025941","DOI":"10.1136\/bmjopen-2018-025941","article-title":"Effect of Frailty on Quality of Life in Elderly Patients after Hip Fracture: A Longitudinal Study","volume":"9","author":"Landers","year":"2019","journal-title":"BMJ Open"},{"key":"ref_3","first-page":"6","article-title":"Excess Mortality for Operated Geriatric Hip Fracture in Hong Kong","volume":"22","author":"Man","year":"2016","journal-title":"Hong Kong Med. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1016\/j.injury.2017.05.017","article-title":"The Weekend Effect for Hip Fracture Surgery","volume":"48","author":"Nijland","year":"2017","journal-title":"Injury"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s11657-020-00873-7","article-title":"Hip Fracture and Mortality: Study of Specific Causes of Death and Risk Factors","volume":"16","author":"Torres","year":"2021","journal-title":"Arch. Osteoporos."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1080\/00365513.2022.2150982","article-title":"Hypoalbuminemia Is Associated with 30-Day Mortality in Hip Fracture Patients Independently of Body Mass Index","volume":"82","author":"Borge","year":"2022","journal-title":"Scand. J. Clin. Lab. Investig."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Blanco, J.F., da Casa, C., Pablos-Hern\u00e1ndez, C., Gonz\u00e1lez-Ram\u00edrez, A., Juli\u00e1n-Enr\u00edquez, J.M., and D\u00edaz-\u00c1lvarez, A. (2021). 30-Day Mortality after Hip Fracture Surgery: Influence of Postoperative Factors. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0246963"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.1001\/jama.2017.17606","article-title":"Association between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery","volume":"318","author":"Pincus","year":"2017","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2825","DOI":"10.1007\/s00264-019-04368-0","article-title":"Altered Seric Levels of Albumin, Sodium and Parathyroid Hormone May Predict Early Mortality Following Hip Fracture Surgery in Elderly","volume":"43","year":"2019","journal-title":"Int. Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.injury.2019.03.031","article-title":"The Impact of Time to Surgery after Hip Fracture on Mortality at 30-and 90-Days: Does a Single Benchmark Apply to All?","volume":"50","author":"Beaupre","year":"2019","journal-title":"Injury"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1186\/s13018-018-0988-6","article-title":"Association between Dementia and Mortality in the Elderly Patients Undergoing Hip Fracture Surgery: A Meta-Analysis","volume":"13","author":"Bai","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1001\/jamainternmed.2014.2362","article-title":"Survival and Functional Outcomes after Hip Fracture among Nursing Home Residents","volume":"174","author":"Neuman","year":"2014","journal-title":"JAMA Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.otsr.2010.07.011","article-title":"Non-Simultaneous Bilateral Hip Fracture: Epidemiologic Study of 241 Hip Fractures","volume":"97","author":"Gaumetou","year":"2011","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Ayg\u00fcn, \u00dc., \u015eenocak, E., Aksay, M.F., \u00c7i\u00e7ek, A.C., Hala\u00e7, O., and Toy, S. (2024). An Overview of Patients with Intertrochanteric Femoral Fractures Treated with Proximal Femoral Nail Fixation Using Important Criteria. BMC Musculoskelet. Disord., 25.","DOI":"10.1186\/s12891-024-08197-0"},{"key":"ref_15","first-page":"276","article-title":"Treatment of Trochanteric Fractures with the PFNA (Proximal Femoral Nail Antirotation) Nail System","volume":"66","author":"Takigami","year":"2008","journal-title":"Bull. NYU Hosp. Jt. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e67","DOI":"10.1016\/j.surge.2020.06.015","article-title":"A Protocol for Wide Awake Local Anaesthetic No Tourniquet (WALANT) Hand Surgery in the Context of the Coronavirus Disease 2019 (COVID-19) Pandemic","volume":"18","author":"Hobday","year":"2020","journal-title":"Surgeon"},{"key":"ref_17","first-page":"e12876","article-title":"A Randomized Controlled Trial Comparing Wide-Awake Local Anesthesia with No Tourniquet (WALANT) to General Anesthesia in Plating of Distal Radius Fractures with Pain and Anxiety Level Perception","volume":"13","author":"Abdullah","year":"2021","journal-title":"Cureus"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"znab134.456","DOI":"10.1093\/bjs\/znab134.456","article-title":"600 the Use of a Wide-Awake Local Anaesthesia No Tourniquet (WALANT) Technique in Foot and Ankle Procedures-a Randomised Control Trial","volume":"108","author":"Borg","year":"2021","journal-title":"Br. J. Surg."},{"key":"ref_19","first-page":"469","article-title":"Wide-Awake Local Anesthesia No Tourniquet (WALANT) versus Local or Intravenous Regional Anesthesia with Tourniquet in Atraumatic Hand Cases in Orthopedics: A Systematic Review and Meta-Analysis","volume":"24","author":"Evangelista","year":"2019","journal-title":"J. Hand Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2309499017739499","DOI":"10.1177\/2309499017739499","article-title":"Perceived Comfort during Minor Hand Surgeries with Wide Awake Local Anaesthesia No Tourniquet (WALANT) versus Local Anaesthesia (LA)\/Tourniquet","volume":"25","author":"Gunasagaran","year":"2017","journal-title":"J. Orthop. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1016\/j.injury.2019.03.011","article-title":"Open Reduction and Internal Fixation of Ankle Fracture Using Wide-Awake Local Anaesthesia No Tourniquet Technique","volume":"50","author":"Li","year":"2019","journal-title":"Injury"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.isjp.2020.03.001","article-title":"Use of Wide-Awake Local Anaesthetic No Tourniquet (WALANT) in Upper Limb and Hand Surgery: A Systematic Review Protocol","volume":"20","author":"Norton","year":"2020","journal-title":"Int. J. Surg. Protoc."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1016\/j.jhsa.2016.11.019","article-title":"Cost Savings and Patient Experiences of a Clinic-Based, Wide-Awake Hand Surgery Program at a Military Medical Center: A Critical Analysis of the First 100 Procedures","volume":"42","author":"Rhee","year":"2017","journal-title":"J. Hand Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"397","DOI":"10.2106\/JBJS.20.00196","article-title":"Ankle Fracture Fixation with Use of WALANT (Wide Awake Local Anesthesia with No Tourniquet) Technique: An Attractive Alternative for the Austere Environment","volume":"103","author":"Tahir","year":"2021","journal-title":"J. Bone Jt. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.2106\/00004623-199507000-00012","article-title":"The Value of the Tip-Apex Distance in Predicting Failure of Fixation of Peritrochanteric Fractures of the Hip","volume":"77","author":"Baumgaertner","year":"1995","journal-title":"J. Bone Jt. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1302\/2058-5241.2.160060","article-title":"Fast Track in Hip Arthroplasty","volume":"2","author":"Hansen","year":"2017","journal-title":"EFORT Open Rev."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1001\/archinte.166.7.766","article-title":"Early Ambulation after Hip Fracture: Effects on Function and Mortality","volume":"166","author":"Siu","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s10195-020-00550-y","article-title":"No Rest for Elderly Femur Fracture Patients: Early Surgery and Early Ambulation Decrease Mortality","volume":"21","author":"Aprato","year":"2020","journal-title":"J. Orthop. Traumatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1111\/j.1445-2197.2006.03786.x","article-title":"No Rest for the Wounded: Early Ambulation after Hip Surgery Accelerates Recovery","volume":"76","author":"Oldmeadow","year":"2006","journal-title":"ANZ J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"397","DOI":"10.4103\/aer.aer_123_22","article-title":"Comparison of Pericapsular Nerve Group Block with Fascia Iliaca Compartment Block in Adult Patients Undergoing Hip Surgeries: A Double-Blinded Randomized Control Study","volume":"16","author":"Kalashetty","year":"2022","journal-title":"Anesth. Essays Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"6685497","DOI":"10.1155\/2021\/6685497","article-title":"Comparison of Effects between Combined Lumbar-Sacral Plexus Block plus General Anesthesia and Unilateral Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery: A Pilot Randomized Controlled Trial","volume":"2021","author":"Tang","year":"2021","journal-title":"Evid. Based Complement. Altern. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S52","DOI":"10.1016\/j.injury.2015.08.014","article-title":"Pain Relief Management Following Proximal Femoral Fractures: Options, Issues and Controversies","volume":"46","author":"Tosounidis","year":"2015","journal-title":"Injury"},{"key":"ref_33","first-page":"859","article-title":"Pericapsular Nerve Group (PENG) Block for Hip Fracture","volume":"43","author":"Peng","year":"2018","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1136\/rapm-2020-101826","article-title":"Analgesia and Anesthesia Using the Pericapsular Nerve Group Block in Hip Surgery and Hip Fracture: A Scoping Review","volume":"46","author":"Morrison","year":"2021","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_35","first-page":"rapm-2018-100277","article-title":"Could the Combination of PENG Block and LIA Be a Useful Analgesic Strategy in the Treatment of Postoperative Pain for Hip Replacement Surgery?","volume":"online ahead of print","author":"Fusco","year":"2019","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_36","first-page":"463","article-title":"Pericapsular Nerve Group Block for Hip Surgery","volume":"86","author":"Reza","year":"2020","journal-title":"Minerva Anestesiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1007\/s00068-021-01670-8","article-title":"The Factors That Affect Blood Loss in Intertrochanteric Fractures Treated with Proximal Femoral Nail in the Elderly","volume":"48","author":"Bilekli","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1097\/BOT.0000000000001183","article-title":"What Is the Influence of a Delay to Surgery >24 Hours on the Rate of Red Blood Cell Transfusion in Elderly Patients With Intertrochanteric or Subtrochanteric Hip Fractures Treated With Cephalomedullary Nails?","volume":"32","author":"Mattisson","year":"2018","journal-title":"J. Orthop. Trauma"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6078\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:34:21Z","timestamp":1760034861000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/17\/6078"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,28]]},"references-count":38,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14176078"],"URL":"https:\/\/doi.org\/10.3390\/jcm14176078","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,8,28]]}}}