Serrano Rafael, Mir Hassan R, Sagi Henry C, Horwitz Daniel S, Borade Amrut, Tidwell John E, Ketz John P, Kistler Brian J, Quade Jonathan H, Beebe Michael J, Au Brigham K, Sanders Roy W, Shah Anjan R
Orthopaedic Trauma Service, Florida Orthopaedic Institute and University of South Florida, Tampa, FL.
Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, OH.
J Orthop Trauma. 2020 Apr;34(4):206-209. doi: 10.1097/BOT.0000000000001666.
To evaluate the rate of, and reasons for, conversion of closed treatment of humeral shaft fractures using a fracture brace, to surgical intervention.
Multicenter, retrospective analysis.
Nine Level 1 trauma centers across the United States.
A total of 1182 patients with a closed humeral shaft fracture initially managed nonoperatively with a functional brace from 2005 to 2015 were reviewed retrospectively from 9 institutions.
Functional brace.
Conversion to surgery.
A total of 344 fractures (29%) ultimately underwent surgical intervention. Reasons for conversion included nonunion (60%), malalignment beyond acceptable parameters (24%), inability to tolerate functional bracing (12%), and persistent signs of radial nerve palsy requiring exploration (3.7%). Univariate comparisons showed that females and whites were significantly (P < 0.05) more likely to be converted to surgery. The multivariate logistic regression identified females as being 1.7 times more likely and alcoholics to be 1.4 times more likely to be converted to surgery (P < 0.05). Proximal shaft as well as comminuted, segmental, and butterfly fractures were also linked to a higher rate of conversion.
This large multicenter study identified a 29% surgical conversion rate, with nonunion as the most common reason for surgical intervention after the failure of functional brace. These results are markedly different than previously reported. These results may be helpful in the future when counseling patients on the choice between functional bracing and surgical intervention in managing humeral shaft fractures.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
评估使用骨折支具对肱骨干骨折进行闭合治疗后转为手术干预的发生率及原因。
多中心回顾性分析。
美国9家一级创伤中心。
对2005年至2015年期间9家机构最初采用功能性支具进行非手术治疗的1182例闭合性肱骨干骨折患者进行回顾性研究。
功能性支具。
转为手术治疗情况。
共有344例骨折（29%）最终接受了手术干预。转为手术的原因包括骨不连（60%）、对线不良超过可接受参数（24%）、无法耐受功能性支具（12%）以及持续性桡神经麻痹体征需要探查（3.7%）。单因素比较显示，女性和白人转为手术的可能性显著更高（P < 0.05）。多因素逻辑回归分析确定女性转为手术的可能性高1.7倍，酗酒者高1.4倍（P < 0.05）。肱骨干近端以及粉碎性、节段性和蝶形骨折也与更高的转为手术率相关。
这项大型多中心研究确定手术转换率为29%，骨不连是功能性支具治疗失败后手术干预的最常见原因。这些结果与先前报道的明显不同。这些结果可能有助于未来在为患者提供肱骨干骨折功能性支具治疗和手术干预选择的咨询时参考。
治疗性四级。有关证据级别的完整描述，请参阅作者指南。
Zotero 插件