Anderson Robert, Parekh Selene, Braid-Forbes Mary Jo, Steen R Grant
Orthopaedic Surgeon, OrthoCarolina, Charlotte, NC.
Professor of Orthopaedic Surgery, North Carolina Orthopaedic Clinic, Department of Orthopaedic Surgery, Duke University, Durham, NC.
J Foot Ankle Surg. 2019 Nov;58(6):1145-1151. doi: 10.1053/j.jfas.2019.03.010. Epub 2019 Sep 20.
The most common fracture in primary care is metatarsal fracture, but it is controversial whether to treat this fracture conservatively or surgically. We performed a cohort study to contrast metatarsal fractures that heal normally with fractures that show delayed healing. We analyzed 5% Medicare Standard Analytic Files, selecting all metatarsal fractures in 2011 to 2013, excluding patients with multiple fractures. Delayed healing was defined as treatment >14 days postfracture with either low-intensity pulsed ultrasound or surgery. Treatment for delayed healing was identified using the Current Procedural Terminology and International Classification of Diseases, Revision 9, Clinical Modification codes. Among 9482 metatarsal fractures, 256 (2.7%) showed delayed healing. Patients with delayed healing were younger (p < .0001); more likely to receive specialist referral (p < .001); more likely to have obesity (p = .005), psychosis (p = .003), chronic lung disease (p = .012), or iron deficiency anemia (p = .016); and more likely to receive surgery before ultrasound (p < .0001). Patients more likely to be treated with surgery than ultrasound included younger patients (p < .0001), obese patients (p = .02), and patients who first see a specialist (p < .05).
基层医疗中最常见的骨折是跖骨骨折，但对于该骨折采取保守治疗还是手术治疗存在争议。我们进行了一项队列研究，以对比正常愈合的跖骨骨折和延迟愈合的骨折。我们分析了5%的医疗保险标准分析文件，选取了2011年至2013年所有的跖骨骨折病例，排除了多处骨折的患者。延迟愈合定义为骨折后14天以上采用低强度脉冲超声或手术治疗。使用当前程序术语和国际疾病分类第9版临床修订版代码确定延迟愈合的治疗情况。在9482例跖骨骨折中，256例（2.7%）出现延迟愈合。延迟愈合的患者更年轻（p < .0001）；更有可能接受专科转诊（p < .001）；更有可能患有肥胖症（p = .005）、精神病（p = .003）、慢性肺病（p = .012）或缺铁性贫血（p = .016）；并且更有可能在超声治疗前接受手术（p < .0001）。比起超声治疗，更有可能接受手术治疗的患者包括年轻患者（p < .0001）、肥胖患者（p = .02）以及首次就诊于专科医生的患者（p < .05）。
