Vaidya Rahul, Sethi Anil, Oliphant Bryant W, Gibson Victor, Sethi Sajiv, Meehan Robert
Orthopedics. 2014 Mar;37(3):e307-12. doi: 10.3928/01477447-20140225-66.
An institutional review board-approved retrospective study was performed at a level 1 trauma center to evaluate the adequacy of current treatment guidelines in the management of humerus fractures following civilian gunshot injuries. Fifty-four patients with a humerus shaft fracture from a low-velocity gunshot wound were included in the study. Twenty-nine patients were treated nonoperatively, while 25 patients had operative treatment, with 14 undergoing plate fixation, 6 having application of an external fixator, 3 receiving an intramedullary rod, and 2 having irrigation and debridement with fracture immobilization provided by a brace. Patient demographics and injury data, radiographic analyses, and treatment complications were recorded. Healing of soft tissue and bony injuries, including fracture alignment in patients treated nonoperatively, was also evaluated. Fifty-two of 54 patients had minor soft tissue damage and were treated successfully with minimal local wound care. Two patients with larger wounds required extended wound care with repeated irrigation and debridement. Overall, 47 of 54 fractures healed with the primary mode of treatment, and 7 patients went on to nonunion requiring further intervention. Of the patients treated nonoperatively, the average deformity was 16.5°±7.4° in the coronal plane and 4.4°±4.0° in the sagittal plane. This study supports the view that the majority of humerus fractures following civilian gunshot wounds may be treated nonoperatively, with a select group of patients requiring surgical stabilization.
在一家一级创伤中心进行了一项经机构审查委员会批准的回顾性研究，以评估当前治疗指南在处理平民枪伤后肱骨骨折方面的充分性。该研究纳入了54例因低速枪伤导致肱骨干骨折的患者。29例患者接受非手术治疗，25例患者接受手术治疗，其中14例进行钢板固定，6例应用外固定架，3例接受髓内钉治疗，2例进行冲洗清创并用支具固定骨折。记录患者的人口统计学和损伤数据、影像学分析以及治疗并发症。还评估了软组织和骨损伤的愈合情况，包括非手术治疗患者的骨折对线情况。54例患者中有52例软组织损伤较轻，经最小限度的局部伤口护理后成功治愈。2例伤口较大的患者需要延长伤口护理时间，反复进行冲洗清创。总体而言，54例骨折中有47例通过初始治疗方式愈合，7例患者出现骨不连，需要进一步干预。在非手术治疗的患者中，冠状面平均畸形为16.5°±7.4°，矢状面为4.4°±4.0°。本研究支持这样一种观点，即大多数平民枪伤后的肱骨骨折可以非手术治疗，只有一小部分患者需要手术稳定治疗。
