Ryan J R
Surg Clin North Am. 1977 Feb;57(1):197-210. doi: 10.1016/s0039-6109(16)41144-8.
The definitive treatment selected for the care of a fracture is dependent upon what will offer the best cosmesis and function for the individual patient. Closed reductions and immobilization which require the joints to be in abnormal positions may offer an anatomic reduction but after the fracture is healed, joint function may be poor. Consequently, immobilization in the functional position with early motion and acceptance of some deformity is often better in terms of the ultimate use of the extremity. Traction treatment which requires prolonged recumbency is dangerous in the elderly because of the threat of thromboembolic phenomena and pneumonia. Therefore, open reduction and internal fixation with early mobilization of such patients is preferred. The type of treatment used is based on an evaluation of the entire patient and not just the radiographic interpretation of the fracture.
为骨折患者选择的最终治疗方案取决于何种方案能为个体患者提供最佳的美观效果和功能。需要关节处于异常位置的闭合复位和固定可能会实现解剖复位，但骨折愈合后，关节功能可能较差。因此，就肢体的最终使用而言，将关节固定在功能位并早期活动，同时接受一定程度的畸形，通常更为可取。由于存在血栓栓塞现象和肺炎的风险，需要长期卧床的牵引治疗对老年人来说很危险。因此，这类患者首选切开复位内固定并早期活动。所采用的治疗类型基于对患者整体的评估，而不仅仅是骨折的影像学解读。
