Lähdeoja Tuomas, Pakkasjärvi Niklas, Aronen Pasi, Willamo Patrick, Aronniemi Johanna, Sintonen Harri, Nietosvaara Yrjänä, Paavola Mika
Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
J Bone Joint Surg Am. 2023 Jun 7;105(11):839-848. doi: 10.2106/JBJS.22.01131. Epub 2023 Apr 21.
The long-term outcomes of a proximal humeral fracture during adolescence are not well known. We investigated the course of primary treatment for these injuries and the long-term outcomes in adulthood, comparing the outcomes with those from age-matched controls. We also compared outcomes after operative and nonoperative treatment via propensity score matching.
We included children who sustained a proximal humeral fracture between the ages of 10.0 and 16.0 years and underwent treatment between 1995 and 2005. Data from primary treatment episodes were extracted from patient files. The patients were invited to a follow-up visit with outcome assessment and radiographs or to a telephone interview if unable to attend. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The secondary outcomes were the Simple Shoulder Test (SST), pain at rest and with strenuous use, shoulder range of motion, strength measurements, health-related quality of life (15D), and harms. Participant results were compared with the normal values of an age-matched population. The effect of operative treatment was assessed using propensity score matching and the average treatment effect was calculated.
This study included 209 patients (210 fractures). The mean follow-up (and standard deviation) was 13.1 ± 3.2 years. Outcome data were obtained from 152 participants (153 fractures); 78 participants attended the follow-up visit. The primary treatment episodes were uneventful. The mean scores were 2.5 (95% confidence interval [CI], 1.8 to 3.3 [range, 0 to 13]) for the DASH and 11.7 (95% CI, 11.5 to 11.8 [range, 8 to 12]) for the SST. Other outcomes were similarly good. There were no differences in function compared with the normal population values. Propensity matching showed no treatment effect for operative treatment compared with nonoperative treatment.
Proximal humeral fractures of adolescents heal well and rarely result in impairments whether treated operatively or nonoperatively.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
青少年肱骨近端骨折的长期预后尚不清楚。我们调查了这些损伤的初始治疗过程及成年后的长期预后，并将结果与年龄匹配的对照组进行比较。我们还通过倾向评分匹配比较了手术和非手术治疗后的结果。
我们纳入了年龄在10.0至16.0岁之间、于1995年至2005年间发生肱骨近端骨折并接受治疗的儿童。从患者病历中提取初始治疗阶段的数据。邀请患者进行随访，进行预后评估并拍摄X光片，若无法前来则进行电话访谈。主要结局指标为上肢、肩部和手部功能障碍（DASH）问卷。次要结局指标为简易肩部测试（SST）、静息及剧烈活动时的疼痛、肩部活动范围测量、力量测量、健康相关生活质量（15D）以及不良事件。将参与者的结果与年龄匹配人群的正常值进行比较。使用倾向评分匹配评估手术治疗的效果并计算平均治疗效果。
本研究纳入209例患者（210处骨折）。平均随访时间（及标准差）为13.1±3.2年。从152名参与者（153处骨折）获取了预后数据；78名参与者参加了随访。初始治疗过程顺利。DASH平均评分为2.5（95%置信区间[CI]，1.8至3.3[范围，0至13]），SST平均评分为11.7（95%CI，1至11.8[范围，8至12]）。其他结局同样良好。与正常人群值相比，功能无差异。倾向匹配显示，与非手术治疗相比，手术治疗无治疗效果。
青少年肱骨近端骨折愈合良好，无论手术治疗还是非手术治疗，很少导致功能障碍。
预后性III级。有关证据水平的完整描述，请参阅作者须知。
