Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh, Edinburgh, Midlothian, UK.
Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh, Edinburgh, Midlothian, UK.
J Shoulder Elbow Surg. 2021 Oct;30(10):2283-2295. doi: 10.1016/j.jse.2021.01.029. Epub 2021 Feb 23.
The primary aim was to identify patient and injury factors independently associated with humeral diaphyseal fracture nonunion after nonoperative management. The secondary aim was to determine the effect of management (operative/nonoperative) on nonunion.
From 2008-2017, a total of 734 humeral shaft fractures (732 consecutive skeletally mature patients) were retrospectively identified from a trauma database. Follow-up was available for 663 fractures (662 patients, 90%) that formed the study cohort. Patient and injury characteristics were recorded. There were 523 patients (79%) managed nonoperatively and 139 (21%) managed operatively. Outcome (union/nonunion) was determined from medical records and radiographs.
The median age at injury was 57 (range 16-96) years and 54% (n = 359/662) were female. Median follow-up was 5 (1.2-74) months. Nonunion occurred in 22.7% (n = 119/524) of nonoperatively managed injuries. Multivariate analysis demonstrated preinjury nonsteroidal anti-inflammatory drugs (NSAIDs; odds ratio [OR] 20.58, 95% confidence interval [CI] 2.12-199.48; P = .009) and glenohumeral arthritis (OR 2.44, 95% CI 1.03-5.77; P = .043) were independently associated with an increased risk of nonunion. Operative fixation was independently associated with a lower risk of nonunion (2.9%, n = 4/139) compared with nonoperative management (OR for nonoperative/operative management 9.91, 95% CI 3.25-30.23; P < .001). Based on these findings, 5 patients would need to undergo primary operative fixation in order to avoid 1 nonunion.
Preinjury NSAIDs and glenohumeral arthritis were independently associated with nonunion following nonoperative management of a humeral diaphyseal fracture. Operative fixation was the independent factor most strongly associated with a lower risk of nonunion. Targeting early operative fixation to at-risk patients may reduce the rate of nonunion and the morbidity associated with delayed definitive management.
本研究的主要目的是确定与肱骨干骨折非手术治疗后不愈合相关的患者和损伤因素。次要目的是确定治疗（手术/非手术）对不愈合的影响。
从 2008 年至 2017 年，从创伤数据库中回顾性确定了 734 例肱骨干骨折（732 例连续成熟骨骼患者）。共有 663 例骨折（662 例患者，90%）获得随访，形成了研究队列。记录了患者和损伤特征。523 例（79%）患者接受非手术治疗，139 例（21%）患者接受手术治疗。从病历和影像学检查确定结局（愈合/不愈合）。
受伤时的中位年龄为 57 岁（范围 16-96 岁），54%（n=359/662）为女性。中位随访时间为 5 个月（1.2-74 个月）。524 例非手术治疗的损伤中，不愈合发生率为 22.7%（n=119/524）。多因素分析显示，伤前使用非甾体抗炎药（NSAIDs；比值比[OR]20.58，95%置信区间[CI]2.12-199.48；P=0.009）和肩关节炎（OR 2.44，95%CI 1.03-5.77；P=0.043）与不愈合风险增加独立相关。与非手术治疗相比，手术固定与不愈合风险降低独立相关（2.9%，n=139 例中的 4 例；非手术/手术治疗的 OR 9.91，95%CI 3.25-30.23；P<.001）。基于这些发现，需要对 5 例患者进行初次手术固定，以避免 1 例不愈合。
伤前使用 NSAIDs 和肩关节炎与肱骨干骨折非手术治疗后不愈合独立相关。手术固定是与不愈合风险降低最密切相关的独立因素。针对高危患者进行早期手术固定可能会降低不愈合率和与延迟确定性治疗相关的发病率。
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