Wilton Alexander, Pananwala Hasitha
Orthopaedics, Northern Sydney Local Health District, Sydney, AUS.
Orthopaedics, Ryde Hospital, Sydney, AUS.
Cureus. 2022 Nov 28;14(11):e31957. doi: 10.7759/cureus.31957. eCollection 2022 Nov.
Non-union of radial neck fractures in adults is rare. This review aims to identify factors contributing to the non-union of undisplaced radial neck fractures and assess treatment options and outcomes. Systematic searches of English articles in PubMed, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews were undertaken in September 2021 according to the PRISMA guidelines. The search terms were (fracture) AND (radial neck) AND (non-union OR non-union). Eligible studies reported adults who experienced undisplaced radial neck fractures that went on to non-union without prior surgical intervention. Fifteen case reports/series were included involving 29 non-unions in 27 patients. The largest study included eight patients. There were 11 males (38%) and 18 females (62%). The average age at the time of the presentation was 55 (range: 29-73). In 13 cases, comorbidities were commented on, including association with smoking in 4 (30%), diabetes in 3 (23%), and excessive alcohol in 5 (38%). The average time from injury to a diagnosis of non-union was 6.7 (range: 2-24) months. The average time of follow-up was 28.6 (range:6-84) months. Eight minimally symptomatic or asymptomatic non-unions were managed conservatively without complication. Seventeen symptomatic non-unions were managed operatively. Treatments included open fixation (1), open fixation with bone grafting (1), bone grafting alone (2), arthroplasty (2), radial head resection (2), and unknown surgery (7). Patients managed operatively achieved full or near-full, asymptomatic range of motion at an average of 5.4 (3-12) months postoperatively. Non-union is a rare complication of an adult radial neck fracture, and risk factors may include female gender, smoking, diabetes, and chronic alcohol. Persistence with non-operative management is encouraged as it can resolve symptoms with or without a radiographic union. Operative options range from bone grafting +/- fixation to arthroplasty. On average, the time from injury to the decision made to operate is 6.5 (3-12) months. A comfortable, functional range of motion is possible with all treatment strategies.
成人桡骨颈骨折不愈合很少见。本综述旨在确定导致无移位桡骨颈骨折不愈合的因素，并评估治疗方案及结果。2021年9月，根据PRISMA指南，在PubMed、Embase、Ovid Medline、Cochrane对照试验中央注册库和Cochrane系统评价数据库中对英文文章进行了系统检索。检索词为（骨折）AND（桡骨颈）AND（不愈合或骨不连）。符合条件的研究报告了成人无移位桡骨颈骨折未经手术干预而发生不愈合的情况。纳入了15篇病例报告/系列研究，涉及27例患者中的29处不愈合。最大的研究纳入了8例患者。有11名男性（38%）和18名女性（62%）。就诊时的平均年龄为55岁（范围：29 - 73岁）。13例病例提到了合并症，包括4例（30%）与吸烟有关，3例（23%）与糖尿病有关，5例（38%）与过度饮酒有关。从受伤到诊断为不愈合的平均时间为6.7个月（范围：2 - 24个月）。平均随访时间为28.6个月（范围：6 - 84个月）。8例症状轻微或无症状的不愈合采用保守治疗，无并发症。17例有症状的不愈合采用手术治疗。治疗方法包括切开复位内固定（1例）、切开复位内固定联合植骨（1例）、单纯植骨（2例）、关节成形术（2例）、桡骨头切除术（2例）和不明手术方式（7例）。接受手术治疗的患者术后平均5.4个月（3 - 12个月）达到完全或接近完全、无症状的活动范围。不愈合是成人桡骨颈骨折的一种罕见并发症，危险因素可能包括女性、吸烟、糖尿病和慢性酒精摄入。鼓励坚持非手术治疗，因为无论影像学上是否愈合，都可以缓解症状。手术选择范围从植骨±内固定到关节成形术。平均而言，从受伤到决定手术的时间为6.5个月（3 - 12个月）。所有治疗策略都有可能实现舒适、功能良好的活动范围。
