Court-Brown Charles M, Aitken Stuart, Hamilton Thomas W, Rennie Louise, Caesar Ben
Royal Infirmary of Edinburgh, Edinburgh, UK.
J Trauma. 2010 Sep;69(3):699-707. doi: 10.1097/TA.0b013e3181b57ace.
Nonoperative fracture treatment has been used for millennia, but there has been no demographic study of its use for half a century. In the last 50 to 60 years, there has been an increased interest in operative fracture fixation and in many specialized Trauma hospitals nonoperative management is less frequently used. However, these specialized hospitals do not reflect fracture treatment in the whole community, and we have undertaken a study to investigate the current prevalence of nonoperative fracture treatment.
A retrospective analysis of 7,863 consecutive fractures in a defined population was undertaken. The use of nonoperative management in different fractures was assessed as was the influence of fracture severity, mode of injury, multiple fractures and social deprivation in the choice of treatment. A comparison of current treatment with that of the 1940s and 1950s was undertaken.
The prevalence of nonoperative treatment was 74.6% with 91.6% of children and 67.6% of adults being treated nonoperatively. There were significant differences in upper and lower limb fractures in both children and adults. The major determinant of nonoperative management was age, although the severity of fracture, mode of injury, and presence of multiple fractures were also important. Social deprivation was not a significant factor except in adult metacarpal fractures.
Nonoperative treatment remains the most widely used method of fracture management. Its prevalence decreases with age, particularly in lower limb fractures. In children, there is a bimodal operative treatment distribution and an increasing prevalence of operative treatment. In some adult fractures, the prevalence of surgery is increasing, but in others, we operate no more frequently than in the 1950s, despite improved operative techniques.
非手术治疗骨折已有数千年历史，但近半个世纪以来一直没有关于其使用情况的人口统计学研究。在过去的50到60年里，人们对手术治疗骨折的兴趣有所增加，在许多专业创伤医院，非手术治疗的使用频率较低。然而，这些专科医院并不能反映整个社区的骨折治疗情况，因此我们进行了一项研究，以调查目前非手术治疗骨折的流行情况。
对特定人群中连续的7863例骨折进行回顾性分析。评估了不同骨折中非手术治疗的使用情况，以及骨折严重程度、损伤方式、多发骨折和社会剥夺对治疗选择的影响。将当前的治疗情况与20世纪40年代和50年代进行了比较。
非手术治疗的流行率为74.6%，其中91.6%的儿童和67.6%的成人接受了非手术治疗。儿童和成人的上肢和下肢骨折存在显著差异。非手术治疗的主要决定因素是年龄，尽管骨折严重程度、损伤方式和多发骨折的存在也很重要。除成人掌骨骨折外，社会剥夺不是一个重要因素。
非手术治疗仍然是最广泛使用的骨折治疗方法。其流行率随年龄增长而降低，尤其是下肢骨折。在儿童中，手术治疗分布呈双峰状，手术治疗的流行率不断增加。在一些成人骨折中，手术的流行率正在上升，但在其他一些骨折中，尽管手术技术有所改进，我们的手术频率并不比20世纪50年代更高。
