von Laer L, Kraus R
Unfallchirurg. 2007 Oct;110(10):811-23. doi: 10.1007/s00113-007-1318-3.
In the treatment of fractures of the long bones in children and adolescents, surgical and conservative methods are not mutually exclusive alternatives; rather, each can complement the other in the overall treatment strategy. Many operative procedures, such as fixation of juxtaarticular, metaphyseal fractures, need to be supplemented by conservative procedures, such as immobilization by means of casts. We refer to methods that are performed without anaesthesia and do not involve the implantation of osteosynthetic foreign material as conservative. These are: immobilization with no further treatment, plaster wedging, and functional treatment options. The indications for purely conservative treatment strategies are basically different for articular and nonarticular fractures. Whereas in the case of articular fractures only the nondisplaced fractures are treated by conservative methods, in the case of nonarticular (shaft) fractures those involving a degree of displacement, as long as it is not too pronounced to allow the integration of spontaneous corrections, can also be treated conservatively.
在治疗儿童和青少年长骨骨折时,手术方法和保守方法并非相互排斥的选择;相反,在整体治疗策略中,二者可以相互补充。许多手术操作,如关节周围、干骺端骨折的固定,需要辅以保守操作,如通过石膏固定。我们将无需麻醉且不涉及植入骨合成异物的方法称为保守方法。这些方法包括:无需进一步治疗的固定、石膏楔形矫正以及功能治疗方案。对于关节骨折和非关节骨折,单纯保守治疗策略的适应证基本不同。在关节骨折的情况下,只有无移位骨折采用保守方法治疗;而在非关节(骨干)骨折的情况下,只要移位程度不太严重以至于无法实现自发矫正,即使存在一定程度的移位,也可以采用保守治疗。