Department of Trauma Surgery, University Medical Centre, Regensburg, Germany.
Department of Trauma Surgery, University Medical Centre, Regensburg, Germany.
Injury. 2021 Jun;52 Suppl 2:S12-S17. doi: 10.1016/j.injury.2020.11.049. Epub 2020 Nov 17.
Although the success story of surgical fracture treatment led to a tremendous improvement of treatment outcome for certain fractures such as femur or tibia shaft fractures, the overall benefit of surgical versus conservative treatment remains controversial for several types of fractures. For this sake, we carried out a narrative review of high-level of evidence studies comparing treatment outcomes in fractures with controversial debates on the value of surgical therapy in clavicle, proximal humerus, olecranon, ankle, calcaneus and Jones fractures. We identified eight studies (Level-I and -2) with functional and quality of life outcomes in these fractures. Only in Jones fractures of the fifth metatarsal bone, bone healing and functional outcomes were significantly better after surgical compared to conservative treatment. In terms of patient-related quality of life, surgical treatment was not found to be superior compared to conservative treatment in all the above-mentioned fractures. In many trials, lower nonunion rates after surgical treatment were offset by complications due to the surgical procedure. Nonunion after conservative treatment often seemed to have only limited impact on functional results. However, the comparability of studies was limited due to age-differences between patients. Therefore, we emphasize the need for further investigations to determine which patient-related factors favor a conservative treatment approach and for whom surgery is the best option.
尽管手术治疗骨折的成功案例极大地改善了某些骨折（如股骨或胫骨骨干骨折）的治疗效果，但对于某些类型的骨折，手术治疗与保守治疗的整体获益仍存在争议。有鉴于此，我们对具有争议性的骨折治疗价值的高水平证据研究进行了叙述性综述，包括锁骨、肱骨近端、鹰嘴、踝关节、跟骨和琼斯骨折。我们共确定了 8 项研究（Ⅰ级和Ⅱ级），这些研究评估了这些骨折的功能和生活质量结局。只有在第五跖骨的琼斯骨折中，手术治疗在骨愈合和功能结局方面明显优于保守治疗。在患者相关的生活质量方面，与保守治疗相比，手术治疗并未在所有上述骨折中显示出优势。在许多试验中，手术治疗后较低的不愈合率因手术相关并发症而被抵消。保守治疗后的不愈合似乎对功能结果的影响有限。然而，由于患者之间的年龄差异，研究的可比性受到限制。因此，我们强调需要进一步的研究来确定哪些与患者相关的因素有利于保守治疗方法，以及对于哪些患者手术是最佳选择。
