Background:

The COVID pandemic challenged the orthopaedic mind on several fronts. 1 of them was in the management of intertrochanteric fractures. A subset of these patients refused surgical intervention during the pandemic for related reasons. Faced with the goal of early verticalisation, the senior author used pain relief as a method to facilitate early mobilisation in 23 patients with peritrochanteric fractures.

Methods:

23 patients with stable intertrochanteric fractures received a β 6 distal sodium channel block (DSCB) and were allowed to walk from day 1 without surgery, traction or spica. The goal was to prevent complications of recumbency in this subset of patients. The basic idea of immediate mobilisation from the time of fracture was based on Sarmiento’s sausage theory.

Results:

All the fractures united. There were no major complications. No shortening was seen in more than 50% cases and the shortening did not exceed 2 cm in any case. All patients were satisfied with the outcome and had good to excellent Harris Hip Scores.

Conclusions:

The block and walk method is a surprisingly satisfactory method of treatment for stable intertrochanteric fractures. It circumvents the risks of surgery whilst allowing immediate mobilisation preventing complications associated with the other modalities of fracture management.

中文翻译：

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转子间骨折保守治疗疼痛缓解后早期活动：大流行强制创新及其结果

背景：

COVID大流行在几个方面挑战了骨科思维。其中 1 人用于处理粗隆间骨折。由于相关原因，其中一部分患者在大流行期间拒绝手术干预。面对早期垂直化的目标，资深作者使用缓解疼痛的方法来促进 23 名转子周围骨折患者的早期活动。

方法：

23 名患有稳定型转子间骨折的患者接受了 β 6 远端钠通道阻滞 (DSCB)，并且从第 1 天起就可以在没有手术、牵引或人字形的情况下行走。目标是防止这部分患者出现卧床并发症。从骨折时立即动员的基本思想是基于萨米恩托的香肠理论。

结果：

所有的骨折都合在一起了。没有重大并发症。在超过 50% 的病例中没有看到缩短，并且在任何情况下缩短不超过 2 厘米。所有患者均对结果感到满意，Harris 髋关节评分良好至极好。

结论：

Block and walk 法是治疗稳定型转子间骨折的一种令人惊讶的令人满意的方法。它规避了手术的风险，同时允许立即动员，防止与其他骨折管理方式相关的并发症。