Raleigh Orthopaedic Clinic, Raleigh, NC, USA.
J Am Acad Orthop Surg. 2013 Sep;21(9):538-47. doi: 10.5435/JAAOS-21-09-538.
The rate of nonunion is estimated to be 1.1% to 10% following closed treatment of proximal humerus fracture and 5.5% following closed treatment of humeral shaft fracture. Surgical management should be considered for fractures that demonstrate no evidence of progressive healing on consecutive radiographs taken at least 6 to 8 weeks apart during the course of closed treatment. In the case of proximal humerus nonunion, recent series have demonstrated union in >90% of patients treated with reconstruction using locking plates and autogenous bone graft. Shoulder arthroplasty is reserved as a salvage option in cases in which the humeral head is not viable or the proximal fragment will not support osteosynthesis. For humeral shaft nonunions, open reduction and internal fixation with compression plating and bone graft remains the standard of care, with a >90% rate of union and good functional outcomes. Recent studies support the use of locked compression plates, dual plating, and cortical allograft struts in patients with osteopenic bone.
闭合治疗肱骨近端骨折后不愈合的发生率估计为 1.1%至 10%，闭合治疗肱骨干骨折后不愈合的发生率为 5.5%。对于在闭合治疗过程中至少相隔 6 至 8 周连续拍摄的影像学检查中没有显示出愈合迹象的骨折，应考虑手术治疗。对于肱骨近端骨不连，最近的系列研究表明，使用锁定钢板和自体骨移植进行重建治疗的患者中，>90%的患者可以愈合。在肱骨头不可存活或近端骨折块无法支持骨固定的情况下，肩关节置换术被保留作为挽救性选择。对于肱骨干骨不连，切开复位和内固定联合加压钢板和骨移植仍然是标准治疗方法，其愈合率>90%，功能结果良好。最近的研究支持在骨质疏松性骨患者中使用锁定加压钢板、双钢板和皮质同种异体骨支柱。
