Mayo Clinic, Rochester, MN, USA.
Travis Air Force Base, CA, USA.
Hand (N Y). 2023 Sep;18(6):1027-1036. doi: 10.1177/15589447211073835. Epub 2022 Feb 21.
Patients with upper limb dysfunction from a brain injury often have different goals of treatment and expectations following a fracture of the upper extremity. This study retrospectively reviewed outcomes of nonoperative management of acute humerus fractures in patients with severe ipsilateral hemiparesis or hemiplegia.
Patients who had sustained an acute humerus fracture managed nonoperatively, greater than 1 year following an upper motor neuron (UMN) injury resulting in ipsilateral severe hemiparesis or hemiplegia at a single tertiary care center from 1988 to 2019, were reviewed. Fractures were classified using the AO-Müller/Orthopaedic Trauma Association and/or Neer classifications. Primary outcome measures included House classification level of function, pain, achievement of and time to radiographic union, and the need for subsequent surgical procedures.
Ten distinct nonoperatively managed humerus fractures-3 proximal (11A23), 5 mid-shaft (12A2b = 1, 12A2c = 2, 12A3a = 1, 12A2b = 1), and 2 distal (13A2 = 1, 13 C1 = 1)-were identified in 8 patients (6 women and 2 men) with ipsilateral hemiparesis or hemiplegia. The median radiographic follow-up was 20 months (range: 78 days to 12 years). The median clinical follow-up was 33.5 months (range: 100 days to 12 years). All patients presented with severe pain that was absent at final follow-up. Radiographic union was achieved in all patients with a mean time to union of 90.9 ± 39.3 days (range: 35-185 days). No patients required operative management.
Nonoperative management of humerus fractures in patients with an ipsilateral UMN injury might result in reliable pain relief and union without the need for further surgical intervention. Management of humerus fractures in this patient population should be individualized toward their goals of care.
上肢运动功能障碍的脑损伤患者在发生同侧上肢骨折后，其治疗目标和期望往往不同。本研究回顾性分析了单一三级医疗中心从 1988 年至 2019 年连续收治的因同侧上运动神经元（UMN）损伤导致严重偏瘫或全瘫的急性肱骨干骨折患者非手术治疗的结果。使用 AO-Müller/骨科创伤协会和/或 Neer 分类法对骨折进行分类。主要结局指标包括 House 功能分级、疼痛、影像学愈合时间、愈合情况及是否需要进一步手术。
在 8 例同侧偏瘫或全瘫患者中发现了 10 处不同的非手术治疗肱骨干骨折（3 处近端[11A23]，5 处中段[12A2b=1、12A2c=2、12A3a=1、12A2b=1]，2 处远端[13A2=1、13C1=1]）。这些患者中有 6 名女性和 2 名男性。影像学随访中位数为 20 个月（范围：78 天至 12 年），临床随访中位数为 33.5 个月（范围：100 天至 12 年）。所有患者在最终随访时均表现出严重疼痛，且疼痛消失。所有患者均实现影像学愈合，平均愈合时间为 90.9±39.3 天（范围：35-185 天）。无患者需要手术治疗。
同侧 UMN 损伤患者肱骨干骨折的非手术治疗可能会获得可靠的止痛效果和愈合效果，而无需进一步手术干预。对这类患者人群的肱骨干骨折的治疗应根据其治疗目标个体化。
