Kandemir Utku, Naclerio Emily H, McKee Michael D, Weatherby David J, Cole Peter A, Tetsworth Kevin
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA.
Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ.
OTA Int. 2023 Jun 16;6(3 Suppl):e259. doi: 10.1097/OI9.0000000000000259. eCollection 2023 Jun.
Current evidence suggests at least one-third of humeral shaft fractures initially managed nonoperatively will fail closed treatment, and this review highlights surgical considerations in those circumstances. Although operative indications are well-defined, certain fracture patterns and patient cohorts are at greater risk of failure. When operative intervention is necessary, internal fixation through an anterolateral approach is a safe and sensible alternative. Determining which patients will benefit most involves shared decision-making and careful patient selection. The fracture characteristics, bone quality, and adequacy of the reduction need to be carefully evaluated for the specific operative risks for individuals with certain comorbid conditions, inevitably balancing the patient's expectations and demands against the probability of infection, nerve injury, or nonunion. As our understanding of the etiology and risk of nonunion and symptomatic malunion of the humeral diaphysis matures, adhering to the principles of diagnosis and treatment becomes increasingly important. In the event of nonunion, respect for the various contributing biological and mechanical factors enhances the likelihood that all aspects will be addressed successfully through a comprehensive solution. This review further explores specific strategies to definitively restore function of the upper extremity with the ultimate objective of an uninfected, stable union.
目前的证据表明，最初采用非手术治疗的肱骨干骨折中，至少有三分之一的患者闭合治疗会失败，本综述重点介绍了在这些情况下的手术考量。尽管手术指征已明确，但某些骨折类型和患者群体失败风险更高。当需要进行手术干预时，经前外侧入路进行内固定是一种安全且合理的选择。确定哪些患者将获益最大需要共同决策并仔细选择患者。对于患有某些合并症的个体，需要仔细评估骨折特征、骨质以及复位的充分性，以确定具体的手术风险，不可避免地要在患者的期望和需求与感染、神经损伤或骨不连的可能性之间进行权衡。随着我们对肱骨干骨不连和有症状畸形愈合的病因及风险的认识逐渐成熟，坚持诊断和治疗原则变得越来越重要。在发生骨不连的情况下，考虑各种生物学和力学因素有助于通过综合解决方案成功解决所有问题。本综述进一步探讨了明确恢复上肢功能的具体策略，最终目标是实现无感染的稳定愈合。
