Department of Orthopaedics, Denver Health Medical Center, Denver, CO.
Department of Orthopaedics, Naval Medical Center, San Diego, CA; and.
J Orthop Trauma. 2023 May 1;37(5):e200-e205. doi: 10.1097/BOT.0000000000002543.
To determine whether the initial radiographic displacement of humeral shaft fractures is associated with failure of nonoperative management.
Retrospective cohort study.
Urban level 1 trauma center.
PATIENTS/PARTICIPANTS: 106 patients with humeral shaft fractures (OTA/AO 12) initially managed nonoperatively.
Functional bracing.
Failure of nonoperative management, defined as conversion to surgery, malunion, and delayed union/nonunion.
Nonoperative management failed in 33 (31%) of 106 included patients with 27 patients (25%) requiring surgery. On multivariate analysis, female sex [odds ratio (OR): 3.50, 95% confidence interval (CI): 1.09 to 11.21], American Society of Anesthesiologist classification >1 (OR: 7.16, CI: 1.95 to 26.29), initial fracture medial/lateral (ML) translation (OR: 1.09, CI: 1.01 to 1.17, per unit change), and initial fracture anterior-posterior (AP) angulation (OR: 1.09, CI: 1.02 to 1.15, per unit change) were independently associated with failure of nonoperative management. Initial fracture displacement values that maximized the sensitivity (SN) and specificity (SP) for failure included an AP angulation >11 degrees (SN 75%, SP 64%) and ML translation >12 mm (SN 55%, SP 75%). The failure rate in patients with none, 1, or both of these fracture parameters was 3.1% (1/32), 35.6% (20/56), and 66.6% (12/18), respectively.
Nearly one-third of patients experienced failure of initial nonoperative management. Failure was found to be associated with greater initial fracture AP angulation and ML translation. Fracture displacement cut-off values were established that may be used by surgeons to counsel patients with these injuries.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定肱骨干骨折的初始放射移位是否与非手术治疗失败有关。
回顾性队列研究。
城市 1 级创伤中心。
患者/参与者：106 例肱骨干骨折（OTA/AO 12）患者，最初接受非手术治疗。
功能支具。
非手术治疗失败，定义为转为手术、畸形愈合和延迟愈合/不愈合。
106 例纳入患者中，非手术治疗失败 33 例（31%），其中 27 例（25%）需要手术。多变量分析显示，女性（比值比 [OR]：3.50，95%置信区间 [CI]：1.09 至 11.21）、美国麻醉医师协会分类>1（OR：7.16，CI：1.95 至 26.29）、初始骨折内外侧（ML）移位（OR：1.09，CI：1.01 至 1.17，每单位变化）和初始骨折前后（AP）成角（OR：1.09，CI：1.02 至 1.15，每单位变化）与非手术治疗失败独立相关。为了最大限度地提高非手术治疗失败的敏感性（SN）和特异性（SP），初始骨折的位移值包括 AP 成角>11 度（SN 为 75%，SP 为 64%）和 ML 位移>12 毫米（SN 为 55%，SP 为 75%）。无、1 个或 2 个这些骨折参数的患者失败率分别为 3.1%（1/32）、35.6%（20/56）和 66.6%（12/18）。
近三分之一的患者经历了初始非手术治疗的失败。发现失败与初始骨折 AP 成角和 ML 移位增加有关。确定了骨折位移截断值，外科医生可以用这些值来为这些损伤的患者提供咨询。
预后 III 级。请参阅作者说明以获取完整的证据水平描述。
