Westrick Edward, Hamilton Benjamin, Toogood Paul, Henley Bradford, Firoozabadi Reza
Orthopaedic and Rehabilitation Institute, 1307 Federal Street, 2nd Floor, Pittsburgh, PA, 15212, USA.
Case Western Reserve University School of Medicine, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
Int Orthop. 2017 Feb;41(2):385-395. doi: 10.1007/s00264-016-3210-7. Epub 2016 May 6.
There has been little direct comparison between non-operative and operative management of humeral shaft fractures. The present study aimed to compare union rates and complication rates between these two modalities of treatment.
A retrospective cohort study was performed at a regional level 1 trauma centre. A total of 296 patients with humeral shaft fractures met inclusion criteria; 69 patients were treated with a functional brace and 227 with surgical intervention. The primary end point was radiographic union. Nonunion was defined as failure of radiological union at six months, requiring surgical intervention. Time to union, nerve palsy rate, and rate of infection were also examined.
The nonunion rate was significantly higher in the non-operative group (23.2 % vs 10.2 %) despite higher rates of open fractures and high energy mechanisms of injury in the operative group. No significant difference in time to union was found. Nerve palsy was more common in the operative group (20 % vs 39 %); however, only two cases (1 %) of radial nerve palsy in the operative group were iatrogenic and both were transient. Infection rates were higher for the operative group (3.5 % vs 0 %).
Conservative treatment of humeral shaft fractures has a higher rate of nonunion, while operative treatment is associated with a low incidence of iatrogenic nerve palsy but higher rates of infection.
肱骨干骨折的非手术治疗与手术治疗之间几乎没有直接比较。本研究旨在比较这两种治疗方式的骨愈合率和并发症发生率。
在一个地区一级创伤中心进行了一项回顾性队列研究。共有296例肱骨干骨折患者符合纳入标准；69例患者采用功能性支具治疗，227例接受手术干预。主要终点是影像学骨愈合。骨不连定义为六个月时影像学骨愈合失败，需要手术干预。还检查了骨愈合时间、神经麻痹发生率和感染率。
非手术组的骨不连发生率显著更高（23.2%对10.2%），尽管手术组的开放性骨折和高能量损伤机制发生率更高。骨愈合时间未发现显著差异。神经麻痹在手术组更常见（20%对39%）；然而，手术组仅两例（1%）桡神经麻痹是医源性的，且均为暂时性。手术组的感染率更高（3.5%对0%）。
肱骨干骨折的保守治疗骨不连发生率更高，而手术治疗医源性神经麻痹发生率低，但感染率更高。
