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Treatment Initial treatment consists of pain-relieving measures and simple splintage of the limb. If operation is delayed, a femoral nerve block may be helpful. A case for non-operative treatment of undisplaced (Garden Stages I and II) fractures can be made in treating patients with advanced dementia and little discomfort. For all others, operative treatment is almost mandatory. Displaced fractures will not unite without internal fixation, and in any case elderly people should be got up and kept active without delay if pulmonary complications and bed sores are to be prevented. Impacted fractures can be left to unite, but there is always a risk that they may become displaced, even while lying in bed, so fixation is safer. Another indication for non-operative management is an impacted Garden I fracture that is an ‘old’ injury, where the diagnosis is made only after the patient has been walking about for several weeks without deleterious effect on the fracture position. When should the operation be performed? In young patients operation is urgent; interruption of the blood supply will produce irreversible cellular changes after 12 hours and, to prevent this, an accurate reduction and stable internal fixation is needed as soon as possible. In older patients, also, the longer the delay, the greater is the likelihood of complications. However, here speed is tempered by the need for adequate preparation, especially in the very elderly, who are often ill and debilitated. What if operation is considered too dangerous? Lying in bed on traction may be even more dangerous, and leaving the fracture untreated too painful; the patient least fit for operation may need it most. ---from 《Apley’s System of Orthopaedics and Fractures》 重点词汇整理： dementia /dɪˈmenʃə/n. [内科] 痴呆 mandatory. /ˈmændətɔːri/adj. 强制的；托管的；命令的n. 受托者（等于mandatary） deleterious /ˌdeləˈtɪriəs/adj. 有毒的，有害的 irreversible cellular changes不可逆转的细胞变化 debilitated. /dɪˈbɪlɪteɪtɪd/adj. 操劳过度的；疲惫不堪的v. 使衰弱（debilitate的过去分词） the patient least fit for operation may need it most.最不适合手术的病人可能最需要手术。 here speed is tempered by the need for adequate preparation,在这里，由于需要充分的准备，速度被削弱了 temper /ˈtempər/n. 脾气；（钢等）回火；性情；倾向vt. 使回火；锻炼；调和；使缓和vi. 回火；调和 百度翻译： 治疗 初期治疗包括止痛措施和简单的肢体夹板固定。如果手术延迟，股神经阻滞可能有帮助。 非手术治疗未移位（花园I期和II期）骨折的病例可用于治疗晚期痴呆症和轻微不适的患者。对于其他所有患者，手术治疗几乎是强制性的。移位的骨折没有内固定是不会愈合的，任何情况下，老年人都应立即起床并保持活动，以防止肺部并发症和褥疮。即使躺在床上也会有骨折移位的危险。 非手术治疗的另一个适应症是一种“陈旧性”损伤的嵌顿I型骨折，只有在患者行走数周后才能做出诊断，而不会对骨折位置产生明显影响。 手术应该在什么时候进行？对于年轻患者来说，手术是紧急的，血液供应中断会在12小时后产生不可逆的细胞变化，为了防止这种情况发生，需要尽快进行精确复位和稳定的内固定。同样，在老年患者中，延迟时间越长，并发症发生的可能性越大。然而，在这里，由于需要充分的准备，速度被削弱了，特别是在老年人，他们经常生病和虚弱。 如果手术被认为太危险了怎么办？躺在床上牵引可能更危险，如果不治疗骨折会很痛苦；最不适合手术的病人可能最需要它。 |
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