Fraser R D, Hunter G A, Waddell J P
J Bone Joint Surg Br. 1978 Nov;60-B(4):510-5. doi: 10.1302/0301-620X.60B4.711798.
The hospital records of 222 cases of ipsilateral fractures of the femur and tibia were reviewed, and patients were grouped according to the type of fracture and the method of treatment. Thirty-five per cent of patients required late operation for delayed union or non-union, osteomyelitis, refracture and malunion, regardless of the treatment group. A disturbing factor was the 30% incidence of osteomyelitis in patients treated by fixation of both fractures, almost three times the incidence when only one fracture was fixed. A 30% incidence of delayed union or non-union occurred in patients managed conservatively. Of sixty-three patients personally examined, the worst results found were those following conservative management of both fractures. More use of rigid external fixation and of cast bracing is recommended in the management of the fractured tibia, combined with internal fixation of the femoral fracture. Examination of the knee suggested that, with ipsilateral fractures, disruption of ligaments is a common occurrence and should always be suspected.
回顾了222例同侧股骨和胫骨骨折的医院记录，并根据骨折类型和治疗方法对患者进行分组。无论治疗组如何，35%的患者因延迟愈合或不愈合、骨髓炎、再骨折和畸形愈合而需要二期手术。一个令人不安的因素是，在两处骨折均采用固定治疗的患者中，骨髓炎的发生率为30%，几乎是仅固定一处骨折时发生率的三倍。保守治疗的患者中延迟愈合或不愈合的发生率为30%。在亲自检查的63例患者中，发现最糟糕的结果是两处骨折均采用保守治疗的患者。建议在胫骨骨折的治疗中更多地使用坚强外固定和石膏支具，并结合股骨骨折的内固定。对膝关节的检查表明，同侧骨折时，韧带断裂很常见，应始终怀疑有韧带断裂。
