Giordano Vincenzo, Belangero William, Pires Robinson Esteves, Labronici Pedro José
1 Serviço de Ortopedia e Traumatologia Professor Nova Monteiro, Hospital Municipal Miguel Couto, Gávea Rio de Janeiro, Brazil.
2 Departamento de Ortopedia e Traumatologia, Universidade Estadual de Campinas, Campinas, Brazil.
J Orthop Surg (Hong Kong). 2017 Sep-Dec;25(3):2309499017727914. doi: 10.1177/2309499017727914.
The purpose of this article is to explore the real-life practice of clinical management of humeral shaft fracture associated with traumatic radial nerve palsy among orthopedic trauma surgeons.
Two hundred seventy-nine orthopedic surgeons worldwide reviewed 10 real cases of a humeral shaft fracture associated with traumatic radial nerve palsy answering two questions: (1) What treatment would you choose/recommend: nonoperative or operative? (2) What are the reasons for your decision-making? The survey was developed in an online survey tool. All participants were active members from AOTrauma International.
Two hundred sixty-six (95.3%) participants were from Latin America and Asia/Pacific. One hundred sixty-two participants (58.1%) had more than 10 years in practice and 178 (63.8%) of them did trauma as the main area of interest. One hundred fifty-one (54.1%) participants treated less than three humeral shaft fractures a month. Traumatic radial nerve palsy was the main reason (88.4%) for surgeons to recommend surgical treatment. Open reduction and internal fixation (ORIF) or percutaneous fixation of the fracture associated with acutely explore of radial nerve was the first option in 62.0% of the cases. A combination of morphology and level of the fracture and the presence of the radial nerve palsy was the most suggested reason to surgically treat the humerus fracture. The main isolated factor was the morphology of the fracture.
Our survey highlight the tendency for a more aggressive management of any humeral shaft fracture associated with a traumatic radial nerve palsy, with surgeons preferring to use ORIF with acute exploration of the radial nerve. Nonsurgical management was the less chosen option among the 279 respondents. Fracture morphology, level of the fracture, and the presence of the radial nerve palsy were most influential for guiding their treatment.
本文旨在探讨骨科创伤外科医生在肱骨干骨折合并创伤性桡神经麻痹临床管理中的实际做法。
全球279名骨科医生回顾了10例肱骨干骨折合并创伤性桡神经麻痹的实际病例，并回答两个问题：（1）你会选择/推荐哪种治疗方法：非手术还是手术？（2）你做出决策的原因是什么？该调查通过在线调查工具进行。所有参与者均为国际AO创伤组织的活跃成员。
266名（95.3%）参与者来自拉丁美洲和亚太地区。162名（58.1%）参与者有超过10年的从业经验，其中178名（63.8%）将创伤作为主要关注领域。151名（54.1%）参与者每月治疗的肱骨干骨折少于3例。创伤性桡神经麻痹是外科医生推荐手术治疗的主要原因（88.4%）。62.0%的病例首选切开复位内固定（ORIF）或骨折经皮固定并同时急性探查桡神经。骨折的形态、水平以及桡神经麻痹的存在是最常被提及的手术治疗肱骨干骨折的原因。主要的独立因素是骨折的形态。
我们的调查突出了对于任何合并创伤性桡神经麻痹的肱骨干骨折采取更积极治疗的趋势，外科医生更倾向于采用ORIF并急性探查桡神经。在279名受访者中，非手术治疗是较少被选择 的选项。骨折形态、骨折水平以及桡神经麻痹的存在对指导他们的治疗最具影响力。
