Hannonen Juuli, Sassi Elina, Hyvönen Hanna, Sinikumpu Juha-Jaakko
Department of Children and Adolescents, Pediatric Surgery and Orthopaedics, Oulu University Hospital, Oulu, Finland.
Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology (PEDEGO Research Unit), University of Oulu, Oulu, Finland.
Front Pediatr. 2020 Nov 5;8:580272. doi: 10.3389/fped.2020.580272. eCollection 2020.
Humeral shaft fractures have traditionally been treated non-operatively due to their good union and low rate of functional impairment. In the recent years, upper extremity fractures and their operative treatment have increased in children. Nevertheless, the trends of humeral shaft fractures are not clear. All children aged <16 years, with a humeral shaft fracture in the geographical catchment area of Northern Finland Hospital District, with a yearly child population-at-risk of ~86 000 from the year 2001 until the end of 2015 were included. There were 88 cases, who comprised the study population. Radiographs were available of all. Injury, patient, and treatment characteristics were reviewed from hospital databases. There was an increasing trend of surgical fixation of humeral shaft fractures during the 15 years' study period (β = 1.266, 95% CI 0.17 to 2.36, = 0.035). However, we found no patient or fracture-related reasons that could have explained the increasing trend of surgical care. Comminuted fracture increased the risk of operative treatment 8-fold (Odds Ratio, OR 7.82, 95% CI 1.69 to 36.3, = 0.009). Higher age, greater angular deformity or greater diameter of the humerus were not associated with the increased operation risk. The treatment philosophy concerning pediatric humeral shaft fractures has presented a shift from conservative care to surgical fixation. To authors' understanding there is not evidence supporting the increasing rate of osteosynthesis.
由于肱骨干骨折愈合良好且功能障碍发生率低，传统上一直采用非手术治疗。近年来，儿童上肢骨折及其手术治疗有所增加。然而，肱骨干骨折的趋势尚不清楚。纳入了芬兰北部医院区地理范围内所有年龄<16岁、患有肱骨干骨折的儿童，从2001年至2015年底，每年的儿童高危人群约为86000人。共有88例病例组成了研究人群。所有病例均有X线片。从医院数据库中回顾了损伤、患者和治疗特征。在15年的研究期间，肱骨干骨折的手术固定呈增加趋势（β=1.266，95%CI 0.17至2.36，P=0.035）。然而，我们没有发现任何患者或骨折相关原因可以解释手术治疗增加的趋势。粉碎性骨折使手术治疗风险增加8倍（优势比，OR 7.82，95%CI 1.69至36.3，P=0.009）。年龄较大（P=0.22）、角度畸形较大（P=0.27）或肱骨直径较大（P=0.89）与手术风险增加无关。小儿肱骨干骨折的治疗理念已从保守治疗转向手术固定。据作者了解，没有证据支持骨合成率的增加。
