Vasara Henri, Aspinen Samuli, Kosola Jussi, Sartanen Juha, Naalisvaara Tuomo, Myllykoski Jan, Stenroos Antti
Department of Hand Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Department of Orthopedics and Traumatology, Kanta-Häme Central Hospital, Hämeenlinna, Finland.
JB JS Open Access. 2023 Aug 16;8(3). doi: 10.2106/JBJS.OA.22.00115. eCollection 2023 Jul-Sep.
The incidence of and risk factors for adverse events after internal fixation of diaphyseal forearm fractures have not been well defined in the current literature. The objective of this study was to estimate the incidence of adverse events after diaphyseal forearm fracture surgery in adults and explore potential risk factors for adverse events.
We conducted a retrospective, multicenter, cohort study in which we evaluated all diaphyseal forearm fractures between 2009 and 2019 in patients presenting to 4 trauma hospitals in southern Finland. Patients <16 years of age and fracture-dislocations were excluded. There were 470 patients included in this study. Patient records were evaluated to identify and analyze adverse events.
There were 202 patients with both-bone fractures, 164 patients with isolated ulnar fractures, and 104 patients with isolated radial fractures. In total, 146 patients (31%) experienced an adverse event; 83 (18%) had major adverse events (persistent or requiring surgical intervention). The patients underwent procedures performed by 185 different surgeons. The median number of operations for a single surgeon was 2 (range, 1 to 12). The most common major adverse events were plate and screw-related issues (6%), nonunion (5%), persistent nerve injuries (4%), and refractures (4%). Higher body mass index, Gustilo-Anderson type-II open fractures, both-bone fractures, isolated radial fractures, and operations performed by junior residents were found to be risk factors for adverse events in the multivariable analysis.
Adverse events after diaphyseal forearm fracture surgery are common. We recommend concentrating these operations in a limited team of surgeons and restricting inexperienced surgeons from operating on these fractures without supervision.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
目前文献中尚未明确肱骨干前臂骨折内固定术后不良事件的发生率及危险因素。本研究的目的是评估成人肱骨干前臂骨折手术后不良事件的发生率，并探讨不良事件的潜在危险因素。
我们进行了一项回顾性、多中心队列研究，评估了2009年至2019年间芬兰南部4家创伤医院收治的所有肱骨干前臂骨折患者。排除年龄<16岁的患者和骨折脱位患者。本研究共纳入470例患者。对患者记录进行评估以识别和分析不良事件。
共有202例双骨折患者、164例单纯尺骨骨折患者和104例单纯桡骨骨折患者。总共有146例患者（31%）发生了不良事件；83例（18%）发生了严重不良事件（持续存在或需要手术干预）。这些患者接受了185位不同外科医生的手术。单个外科医生的手术中位数为2次（范围为1至12次）。最常见的严重不良事件是钢板和螺钉相关问题（6%）、骨不连（5%）、持续性神经损伤（4%）和再骨折（4%）。多变量分析发现，较高的体重指数、Gustilo-Anderson II型开放性骨折、双骨折、单纯桡骨骨折以及初级住院医师进行的手术是不良事件的危险因素。
肱骨干前臂骨折手术后不良事件很常见。我们建议将这些手术集中在一个有限的外科医生团队中进行，并限制无经验的外科医生在无监督的情况下对这些骨折进行手术。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
