Archer L A, Furey A
Department of Orthopaedic Surgery, Memorial University of Newfoundland Health Sciences Center, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada.
Musculoskelet Surg. 2016 Dec;100(3):213-216. doi: 10.1007/s12306-016-0425-0. Epub 2016 Sep 20.
Avascular necrosis (AVN) of the humeral head is a devastating complication of proximal humeral fracture (PHF) that often results in long-term morbidity for the patient. Rates of AVN depend on the number of fracture fragments and are highly variable. The literature suggests that timely stable and anatomic reduction may decrease the rate at which AVN develops after PHF. To our knowledge, there is no literature published investigating a temporal relationship between the timing of PHF fixation and rates of AVN.
Operative records of one orthopedic trauma surgeon were used to identify patients that underwent open reduction internal fixation for PHF at our institution between 2007 and 2012. Radiographs at presentation were reviewed and used to classify the fractures into two, three or four parts. Date and time of the initial radiograph were recorded as were the date and time of available intra-operative fluoroscopic images. The time from presentation radiograph to operative fixation was calculated (hours). Available follow-up plain films were then reviewed and evaluated for the presence or absence of humeral head AVN.
Time to surgery (less than or greater than 72 h) and patient age did not correlate with development of AVN after PHF (p > 0.26). Notably, the number of fracture fragments did influence the rate of AVN identified in patients with PHF (p = 0.002).
Early operative intervention does not appear to decrease the rate of development of avascular necrosis after PHF.
肱骨头缺血性坏死（AVN）是肱骨近端骨折（PHF）的一种严重并发症，常给患者带来长期病痛。AVN的发生率取决于骨折碎片的数量，且差异很大。文献表明，及时进行稳定且解剖复位可能会降低PHF后AVN的发生率。据我们所知，尚无文献研究PHF固定时间与AVN发生率之间的时间关系。
利用一名骨科创伤外科医生的手术记录，确定2007年至2012年期间在我们机构接受PHF切开复位内固定的患者。回顾就诊时的X线片，并用于将骨折分为两部分、三部分或四部分。记录初始X线片的日期和时间以及术中可用的透视图像的日期和时间。计算从就诊X线片到手术固定的时间（小时）。然后回顾可用的随访平片，并评估是否存在肱骨头AVN。
手术时间（小于或大于72小时）和患者年龄与PHF后AVN的发生无关（p>0.26）。值得注意的是，骨折碎片的数量确实影响了PHF患者中AVN的发生率（p=0.002）。
早期手术干预似乎并不能降低PHF后缺血性坏死的发生率。
