Gladstein A Z, Schade A T, Howard A W, Camp M W
Pennsylvania Hospital, Sports Medicine, 800, Spruce street, Philadelphia, PA 19103 United States; Texas Children's Hospital Department of Orthopaedic Surgery, 6620 Fannin, St. Houston, TX 77030, United States.
Royal Stoke University Hospitals, Stoke on Trent, St4-6QG, United Kingdom.
Orthop Traumatol Surg Res. 2017 Feb;103(1):115-118. doi: 10.1016/j.otsr.2016.09.022. Epub 2016 Nov 25.
The majority of proximal humeral fractures in the skeletally immature are treated non-operatively. Operative indications vary but are largely based on degree of displacement. Non-union is rare. Non-operatively treated fractures are typically monitored radiographically to assess healing.
We hypothesize that the decision to treat fractures operatively is made at the time of first imaging and that follow-up X-rays do not lead to a change in management.
We retrospectively reviewed the records of 239 patients treated for proximal humerus fractures over a 5-year period. There were 225 who were treated non-operatively. Records were reviewed for the number of clinic visits and radiographs, as well as any change to operative management based on follow-up X-rays.
The primary outcome of the study was the proportion of proximal humerus fractures, initially treated non-operatively, for which displacement or angulation on follow-up radiographs led to a change to operative treatment. Secondary outcomes were the number of follow-up radiographs obtained after the initial diagnosis and initiation of non-operative treatment. Of the 225 patients that were initially managed non-operatively, only 1 patient required subsequent surgical management. This patient underwent a proximal humerus epiphysiodesis 365 days from injury after development of a partial growth arrest. The mean number of fracture clinic visits for patients managed non-operatively was 2.67 (±1.24). The mean number of radiology department visits and radiographs obtained was 3.57 (±1.44) and 8.36 (±3.89) respectively. No clinical or radiographic non-unions were identified in these patients. No patients suffered a refracture during the review period.
This study shows that of the 239 uncomplicated pediatric proximal humerus fractures treated at our hospital over a 5-year period, only 1 had a change in treatment plan, from non-operative to operative, based on follow-up radiographs. These data suggest that non-operative treatment of proximal humerus fractures seldom results in displacement that warrants operative intervention. Moreover, they suggest that there is little utility to the routine use of postoperative radiographs in follow-up of these patients.
Retrospective case series.
IV.
骨骼未成熟患者的大多数肱骨近端骨折采用非手术治疗。手术指征各不相同，但主要基于移位程度。骨不连很少见。非手术治疗的骨折通常通过影像学检查进行监测以评估愈合情况。
我们假设在首次成像时就做出了手术治疗骨折的决定，并且后续的X线检查不会导致治疗方案的改变。
我们回顾性分析了5年间239例肱骨近端骨折患者的记录。其中225例接受非手术治疗。审查记录中的门诊就诊次数和X线片数量，以及基于后续X线检查对手术治疗方案的任何改变。
该研究的主要结果是，最初接受非手术治疗的肱骨近端骨折患者中，因后续X线片显示移位或成角而改为手术治疗的比例。次要结果是在初始诊断和开始非手术治疗后获得的后续X线片数量。在最初接受非手术治疗的225例患者中，只有1例需要后续手术治疗。该患者在受伤365天后，因出现部分生长停滞而接受了肱骨近端骨骺阻滞术。非手术治疗患者的骨折门诊平均就诊次数为2.67（±1.24）次。放射科的平均就诊次数和获得的X线片数量分别为3.57（±1.44）次和8.36（±3.89）张。这些患者中未发现临床或影像学骨不连。在审查期间没有患者发生再骨折。
本研究表明，在我院5年间治疗的239例单纯性儿童肱骨近端骨折中，只有1例基于后续X线检查改变了治疗方案，从非手术改为手术。这些数据表明，肱骨近端骨折的非手术治疗很少导致需要手术干预的移位。此外，这些数据表明，在这些患者的随访中常规使用术后X线片的作用不大。
回顾性病例系列。
四级。
