[THE SURGERY EPIDEMIC AND TIBIAL SHAFT FRACTURES: CONSERVATIVE FUNCTIONAL TREATMENT ALGORITHM FOR TIBIAL SHAFT...

With the emergence in recent years of advanced surgical methods for treatment of diaphyseal fractures of the tibia bone, there appears to be a decline in the familiarity and use of the conservative treatment based on weight bearing casts and early weight bearing. This phenomenon, dubbed "the surgery epidemic" by Dr. Sarmiento, one of the forefathers of tibial fractures treatment, refers to orthopedics surgeons' tendency to treat surgically, even in patients viable for conservative treatment.

In this study, we examined all the patients with diaphyseal tibial fracture who were treated at the Orthopedic ward at "Rambam" Hospital in the study period (2012-2016), in order to evaluate the results of the conservative functional treatment, to identify the different stages of said treatment, and to create a clear and accessible protocol for treating physicians. In addition, we sought to examine whether there is a preference for surgical treatment among physicians, even in cases where fracture characteristics, according to accepted criteria, would have allowed for conservative treatment.

Clinical and radiological evaluation of all patients who arrived with tibia bone fractures to "Rambam" hospital in the study period (2012-2106); identifying patients who fit the criteria for conservative functional treatment and were treated either conservatively or surgically. In those who were treated conservatively we documented the course of their treatment until full recovery.

A total of 153 patients with tibial bone fracture were admitted in the study period. Of those patients, 15 were treated according to the conservative functional treatment, 33 were treated surgically despite their adherence to the conservative treatment guidelines. Of all the patients adhering to the conservative treatment criteria (48 patients), only 31.2% were treated conservatively, while 68.8% were treated surgically, unnecessarily, some would say. In other words, 25% of all the patients treated surgically for tibial bone fracture, could have been treated conservatively but instead were treated surgically with internal fixation in accordance to their surgeon's preference.

In this study we observed a clear preference for surgical treatment in tibial bone fractures, even in cases where the fracture position met the accepted criteria for conservative treatment. We found that the conservative functional treatment, as practiced in our hospital, adheres to the highest standard of care. Taking into account surgery and anesthesia complications, and its added cost to the health care system, we believe it is appropriate to increase awareness among physicians to the possibility and benefits of conservative functional treatment that allows for early weight bearing and patient activity.