Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center.
Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
J Pediatr Orthop B. 2022 May 1;31(3):274-280. doi: 10.1097/BPB.0000000000000863.
Spiral fractures in the distal third humerus shaft (Holstein-Lewis fracture pattern) have been associated with high risk of radial nerve palsy in adults and surgical treatment is recommended as the treatment of choice to remove the entrapped nerve from the fracture site. But this association and treatment approach has not been evaluated in pediatric humerus shaft fractures. In a retrospective study, 38 pediatric patients with Holstein-Lewis fracture configuration were identified after a review of radiographs of 1609 patients with humerus shaft fracture. Age at initial presentation, sex, mechanism of injury, side involved, presence of any associated injuries, neurovascular status, radial nerve status, fracture management, and any complications were noted. Thiry-three (86.8%) patients with mean age 10.1 ± 3.7 years were successfully treated by closed methods. Five patients (13.2%) with mean age 15.2 ± 2.6 years underwent surgical treatment. Contrary to adults, no children/adolescents had radial nerve palsy at presentation. Radiographic healing was acceptable in all cases at latest follow-up. Holstein-Lewis fracture behaves differently in children with no increased risk of radial nerve palsy. Majority can be treated conservatively. The thick periosteum in children may offer protection to the radial nerve and may be responsible for the success of closed treatment.
肱骨远端三分之一螺旋形骨折（Holstein-Lewis 骨折模式）与成人桡神经麻痹的高风险相关，建议手术治疗是去除骨折部位神经嵌顿的首选治疗方法。但这种关联和治疗方法尚未在儿童肱骨骨干骨折中进行评估。在一项回顾性研究中，对 1609 例肱骨骨干骨折的 X 线片进行回顾性分析后，发现了 38 例具有 Holstein-Lewis 骨折形态的儿童患者。记录了初次就诊时的年龄、性别、损伤机制、受累侧、是否存在任何相关损伤、神经血管状态、桡神经状态、骨折处理以及任何并发症。33 例（86.8%）平均年龄 10.1±3.7 岁的患者成功接受了闭合治疗。5 例（13.2%）平均年龄 15.2±2.6 岁的患者接受了手术治疗。与成人不同，就诊时没有儿童/青少年出现桡神经麻痹。在最新随访时，所有病例的影像学愈合均可接受。Holstein-Lewis 骨折在儿童中表现不同，没有增加桡神经麻痹的风险。大多数患者可以保守治疗。儿童较厚的骨膜可能为桡神经提供保护，这可能是闭合治疗成功的原因。
