Cohen Israel, Keren Yaniv
Orthopedic Department, Rambam Hospital.
Harefuah. 2020 Mar;159(3):158-162.
With the emergence in recent years of advanced surgical methods for treatment of diaphyseal fractures of the tibia bone, there appears to be a decline in the familiarity and use of the conservative treatment based on weight bearing casts and early weight bearing. This phenomenon, dubbed "the surgery epidemic" by Dr. Sarmiento, one of the forefathers of tibial fractures treatment, refers to orthopedics surgeons' tendency to treat surgically, even in patients viable for conservative treatment.
In this study, we examined all the patients with diaphyseal tibial fracture who were treated at the Orthopedic ward at "Rambam" Hospital in the study period (2012-2016), in order to evaluate the results of the conservative functional treatment, to identify the different stages of said treatment, and to create a clear and accessible protocol for treating physicians. In addition, we sought to examine whether there is a preference for surgical treatment among physicians, even in cases where fracture characteristics, according to accepted criteria, would have allowed for conservative treatment.
Clinical and radiological evaluation of all patients who arrived with tibia bone fractures to "Rambam" hospital in the study period (2012-2106); identifying patients who fit the criteria for conservative functional treatment and were treated either conservatively or surgically. In those who were treated conservatively we documented the course of their treatment until full recovery.
A total of 153 patients with tibial bone fracture were admitted in the study period. Of those patients, 15 were treated according to the conservative functional treatment, 33 were treated surgically despite their adherence to the conservative treatment guidelines. Of all the patients adhering to the conservative treatment criteria (48 patients), only 31.2% were treated conservatively, while 68.8% were treated surgically, unnecessarily, some would say. In other words, 25% of all the patients treated surgically for tibial bone fracture, could have been treated conservatively but instead were treated surgically with internal fixation in accordance to their surgeon's preference.
In this study we observed a clear preference for surgical treatment in tibial bone fractures, even in cases where the fracture position met the accepted criteria for conservative treatment. We found that the conservative functional treatment, as practiced in our hospital, adheres to the highest standard of care. Taking into account surgery and anesthesia complications, and its added cost to the health care system, we believe it is appropriate to increase awareness among physicians to the possibility and benefits of conservative functional treatment that allows for early weight bearing and patient activity.
近年来，随着治疗胫骨干骨折的先进手术方法的出现，基于负重石膏和早期负重的保守治疗的熟悉程度和使用似乎有所下降。这种现象被胫骨骨折治疗的先驱之一萨米恩托博士称为“手术流行”，指的是骨科医生倾向于进行手术治疗，即使是对于适合保守治疗的患者。
在本研究中，我们检查了研究期间（2012 - 2016年）在“兰巴姆”医院骨科病房接受治疗的所有胫骨干骨折患者，以评估保守功能治疗的结果，确定该治疗的不同阶段，并为治疗医生创建一个清晰易懂的方案。此外，我们试图研究即使在根据公认标准骨折特征允许保守治疗的情况下，医生是否存在对手术治疗的偏好。
对研究期间（2012 - 2016年）因胫骨骨折到“兰巴姆”医院就诊的所有患者进行临床和放射学评估；确定符合保守功能治疗标准并接受保守或手术治疗的患者。对于接受保守治疗的患者，我们记录其直至完全康复的治疗过程。
研究期间共收治153例胫骨骨折患者。其中，15例接受保守功能治疗，33例尽管符合保守治疗指南但仍接受了手术治疗。在所有符合保守治疗标准的患者（48例）中，只有31.2%接受了保守治疗，而68.8%接受了不必要的手术治疗，可以这么说。换句话说，所有接受胫骨骨折手术治疗的患者中有25%本可以接受保守治疗，但却根据其外科医生的偏好接受了内固定手术治疗。
在本研究中，我们观察到即使骨折位置符合保守治疗的公认标准，在胫骨干骨折中也明显倾向于手术治疗。我们发现，我院实施的保守功能治疗符合最高护理标准。考虑到手术和麻醉并发症以及其给医疗保健系统增加的成本，我们认为有必要提高医生对允许早期负重和患者活动的保守功能治疗的可能性和益处的认识。
