Nonoperative Fracture Treatment in the Modern Era

Abstract

Nonoperative treatment remains the most widely used method of fracture management. Its prevalence decreases with age, particularly in lower limb fractures. In children, there is a bimodal operative treatment distribution and an increasing prevalence of operative treatment. In some adult fractures, the prevalence of surgery is increasing, but in others, we operate no more frequently than in the 1950s, despite improved operative techniques.

Clinical Research Fails to Support More Aggressive Management of Pediatric Upper Extremity Fractures

“…treatment has increased more rapidly for children with upper extremity fractures than it has for those with lower extremity fractures 2 and more for children in the Northeast than for children in the rest of the United States 3 , possibly due to differences in health-care access, the availability of technology, and regional and cultural values. Similar trends have been identified in Europe and Asia 1,2,4 .…”

“…Specifically, from 1951 to 2000, surgical treatment rates have increased for fractures to the distal portion of the humerus (7.6%) and radius (15.7%) and the diaphyseal portion of the humerus (12.5%), ulna (18.5%), and radius and ulna (11.5%) as well as the carpals (2.8%) 1 . The percentage of hospital-treated pediatric upper extremity fractures treated with surgery has increased by 4%, from 83% in 1997 to 87% in 2006 2 .…”

Inhibition of sclerostin by monoclonal antibody enhances bone healing and improves bone density and strength of nonfractured bones

“…Thus a therapeutic agent that improves outcomes could have important clinical benefits. In addition, most fractures are managed nonoperatively (29) ; therefore there is a great need for a noninvasive systemic therapy that could accelerate healing in these settings. The temporal effects of Scl-Ab on the composition and progression of healing fractures will be the subject of future studies.…”

Sclerostin monoclonal antibodies on bone metabolism and fracture healing

“…They can be difficult to treat due to the multifragmentary nature of the fractures, poor bone stock, reduced implant fixation and fracture healing. The majority of fractures can be managed non-operatively [59], therefore, it can be highly relevant in this setting. Hip fractures are a high burden on healthcare systems and can have an adverse effect on functional ability and quality of life.…”