Sudah Suleiman Y, Puzzitiello Richard N, Nasra Matthew H, Moverman Michael A, Pagani Nicholas R, Guss Michael S, Menendez Mariano E
Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch, NJ, USA.
Department of Orthopedic Surgery, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
JSES Rev Rep Tech. 2021 Nov 12;2(1):96-102. doi: 10.1016/j.xrrt.2021.10.001. eCollection 2022 Feb.
Distal humerus fractures (DHFs) pose a treatment challenge in elderly patients. We sought to systematically review and report the clinical outcomes of the nonoperative approach (eg, "bag of bones") for the treatment of these injuries and the rate of conversion to delayed surgery.
A comprehensive review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted. Studies involving outcomes after nonoperative treatment of DHF in patients >65 years of age were included from 1985 to present. Data regarding patient age, DHF type, nonoperative treatment method, complications, conversion to delayed surgery, range of motion, union rate, and surgeon- and patient-reported outcome measures were extracted.
A total of five studies met inclusion criteria (all level IV evidence), yielding a total of 143 patients (mean age: 73.5 years to 87.4 years) with 7.1 months to 55 months of follow-up. The mean Mayo Elbow Performance Index scores were good to excellent across several studies (range 83-93.1). Multiple studies reported good range of motion (mean arc of motion: 81 to 106 degrees) and low levels of upper extremity disability (mean Quick Disability of the Arm-Shoulder-Hand scores: 31.3 to 38.5) at the final follow-up. The rate of conversion to total elbow arthroplasty and operative fixation ranged from 0% to 7.5% and 0% to 5%, respectively.
Nonoperative management of distal humerus fractures in the elderly seems to be associated with acceptable functional outcomes and low rates of delayed surgery. This information is important for patient counseling and treatment decision-making.
肱骨远端骨折（DHFs）给老年患者的治疗带来挑战。我们试图系统回顾并报告非手术治疗方法（如“骨袋”法）治疗这些损伤的临床结果以及延迟手术的转化率。
按照系统评价和Meta分析的首选报告项目指南对文献进行全面回顾。纳入1985年至今有关65岁以上患者非手术治疗DHF后结果的研究。提取有关患者年龄、DHF类型、非手术治疗方法、并发症、延迟手术转化率、活动范围、愈合率以及外科医生和患者报告的结局指标的数据。
共有五项研究符合纳入标准（均为IV级证据），共143例患者（平均年龄73.5岁至87.4岁），随访时间为7.1个月至55个月。多项研究中，平均梅奥肘关节功能指数评分良好至优秀（范围83 - 93.1）。多项研究报告，末次随访时活动范围良好（平均活动弧度：81至106度），上肢残疾程度低（平均肩肘手快速残疾评分：31.3至38.5）。全肘关节置换术和手术固定的转化率分别为0%至7.5%和0%至5%。
老年肱骨远端骨折的非手术治疗似乎与可接受的功能结果和低延迟手术率相关。该信息对患者咨询和治疗决策很重要。
