Jawa Andrew, McCarty Pearce, Doornberg Job, Harris Mitch, Ring David
Department of Orthopaedic Surgery, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114, USA.
J Bone Joint Surg Am. 2006 Nov;88(11):2343-7. doi: 10.2106/JBJS.F.00334.
There are strong advocates for both operative and nonoperative treatment of distal-third diaphyseal fractures of the humerus, but there are few comparative data. We performed a retrospective comparison of these two treatment methods.
Fifty-one consecutive patients with a closed, extra-articular fracture of the distal one-third of the humeral diaphysis were identified from an orthopaedic trauma database. Forty patients were followed for at least six months or until healing of the fracture. Eleven patients were excluded because of inadequate follow-up. Nineteen patients had been managed with plate-and-screw fixation, and twenty-one had been managed with functional bracing.
Among the operatively treated patients, one had loss of fixation, one had a postoperative infection, and one required tendon transfers for the treatment of a preoperative radial nerve palsy that did not resolve. Three new postoperative radial nerve palsies developed, and one had not resolved when the patient was last evaluated, three months after surgery. All operatively treated fractures healed with <10 degrees of angular deformity, and one patient lost 20 degrees of shoulder or elbow motion. Among the nonoperatively treated fractures, two were converted to plate fixation because of the treating surgeons' concern regarding alignment and radial nerve palsy. Only one patient had >30 degrees of malalignment in any plane. Two patients had development of skin breakdown during treatment and completed treatment in a sling. Two patients lost >/=20 degrees of elbow or shoulder motion.
For extra-articular distal-third diaphyseal humeral fractures, operative treatment achieves more predictable alignment and potentially quicker return of function but risks iatrogenic nerve injury and infection and the need for reoperation. Functional bracing can be associated with skin problems and varying degrees of angular deformity, but function and range of motion are usually excellent.
肱骨远端三分之一骨干骨折的手术治疗和非手术治疗均有坚定的支持者，但对比数据较少。我们对这两种治疗方法进行了回顾性比较。
从骨科创伤数据库中确定了51例连续的肱骨远端三分之一骨干闭合性关节外骨折患者。40例患者随访至少6个月或直至骨折愈合。11例患者因随访不足被排除。19例患者采用钢板螺钉固定治疗，21例患者采用功能支具治疗。
在接受手术治疗的患者中，1例出现内固定失败，1例发生术后感染，1例因术前未缓解的桡神经麻痹需要进行肌腱转位治疗。术后出现3例新发桡神经麻痹，1例在术后3个月最后一次评估时仍未缓解。所有接受手术治疗的骨折愈合时角度畸形均<10度，1例患者肩部或肘部活动度丧失20度。在接受非手术治疗的骨折中，2例因治疗医生担心对线和桡神经麻痹而改为钢板固定。只有1例患者在任何平面上的畸形>30度。2例患者在治疗期间出现皮肤破损，最终用吊带完成治疗。2例患者肘部或肩部活动度丧失≥20度。
对于关节外肱骨远端三分之一骨干骨折，手术治疗可实现更可预测的对线，功能恢复可能更快，但存在医源性神经损伤、感染及再次手术的风险。功能支具可能会出现皮肤问题和不同程度的角度畸形，但功能和活动范围通常良好。
