Cho Elizabeth, Schoenfeldt Theodore, McMartin Tyler, Summers Hobie, Cohen Joseph B, Levack Ashley E
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA.
Stritch School of Medicine, Loyola University, Maywood, IL, USA.
J Clin Orthop Trauma. 2023 Oct 7;44:102248. doi: 10.1016/j.jcot.2023.102248. eCollection 2023 Sep.
Humeral shaft fractures are common injuries treated by orthopaedic surgeons. The purpose of this study is to evaluate displaced diaphyseal humerus fractures and describe the incidence and characteristics associated with non or minimally displaced fracture line extension into the proximal metadiaphyseal region of the humerus.
All adult patients with diaphyseal humeral shaft fractures located within the distal two-thirds of the humeral shaft, treated at a single level I trauma institution between 2007 and 2020, were retrospectively identified. 202 patients with 203 fractures of the humeral shaft were included. Fracture patterns were classified according to AO/OTA classification and fracture line extension into the proximal metadiaphyseal region was evaluated on radiographs. Patient demographics, management details, and radiographic outcomes were obtained from review of the electronic medical record.
Of 203 diaphyseal humerus fractures, 11.8 % (n = 24) had non or minimally displaced proximal extension of their main fracture line. This included 43.7 % (n = 7) of all proximal third junction diaphyseal fractures, 10.7 % (n = 16) of all middle third diaphyseal fractures, and 2.6 % (n = 1) of all distal third diaphyseal fractures. Patients with proximal fracture extension were, on average, older (61.7 versus 44.4 years, p < 0.001), and a higher percentage were female (75 % versus 45.5 %, p < 0.01) compared to patients without fracture proximal extension. Fractures with proximal extension were all closed fractures (n = 24), were more often sustained from low-energy fall (87.5 % versus 35.2 %, p < 0.001), and were more often spiral type fractures (62.5 % versus 17.2 %). Fractures with proximal extension were more often treated non-operatively (58.3 % versus 42.1 %, p < 0.01), but were found to have a higher rate of nonunion after non-operative treatment (17.6 % versus 8.1 %) compared to fractures without proximal extension. All operatively treated fractures that had proximal metaphyseal extension were secured with a fixation construct to achieve fixation proximal to the extent of the fracture line, most often into the humeral head and neck. Operative management with proximal fixation into the humeral head was also pursued for a patient with nonunion, including persistent lucency of the proximal extension line, after failed non-operative treatment. Mean follow-up was 35.5 weeks (range: 0-607 weeks).
Proximal fracture line extension in the setting of diaphyseal humerus fractures is not uncommon. Detection and consideration of this sometimes subtle finding is important when planning to treat these injuries operatively.
肱骨干骨折是骨科医生常治疗的损伤。本研究的目的是评估移位的肱骨干骨折，并描述与骨折线未移位或轻微移位延伸至肱骨近端干骺端区域相关的发生率和特征。
回顾性确定2007年至2020年期间在一家一级创伤机构接受治疗的所有成年肱骨干骨折患者，这些骨折位于肱骨干远端三分之二范围内。纳入202例患者的203处肱骨干骨折。根据AO/OTA分类对骨折类型进行分类，并通过X线片评估骨折线向近端干骺端区域的延伸情况。通过查阅电子病历获取患者人口统计学资料、治疗细节和影像学结果。
在203处肱骨干骨折中，11.8%（n = 24）的主要骨折线有未移位或轻微移位的近端延伸。这包括所有近端三分之一交界处肱骨干骨折的43.7%（n = 7）、所有中段三分之一肱骨干骨折的10.7%（n = 16）以及所有远端三分之一肱骨干骨折的2.6%（n = 1）。与无近端骨折延伸的患者相比，有近端骨折延伸的患者平均年龄更大（61.7岁对44.4岁，p < 0.001），女性比例更高（75%对45.5%，p < 0.01）。有近端延伸的骨折均为闭合性骨折（n = 24）；更常因低能量跌倒所致（87.5%对35.2%，p < 0.001），且更常为螺旋型骨折（62.5%对17.2%）。有近端延伸的骨折更常采用非手术治疗（58.3%对42.1%，p < 0.01），但与无近端延伸的骨折相比，非手术治疗后骨不连发生率更高（17.6%对8.1%）。所有接受手术治疗且有近端干骺端延伸的骨折均采用固定结构进行固定，以在骨折线范围近端实现固定，最常固定至肱骨头和颈部。对于一名非手术治疗失败后出现骨不连（包括近端延伸线持续透亮）的患者，也采用了将近端固定至肱骨头的手术治疗方法。平均随访35.5周（范围：0 - 607周）。
肱骨干骨折时近端骨折线延伸并不少见。在计划对这些损伤进行手术治疗时，发现并考虑这一有时较为细微的发现很重要。
