Chowdhury Alex, Peters Kizzie A, Colaço Henry B, MacLeod Iain Ar
Department of Trauma and Orthopaedics, Hampshire Hospitals Foundation Trust, Winchester, UK.
Shoulder Elbow. 2024 Oct;16(6):611-620. doi: 10.1177/17585732231190325. Epub 2023 Aug 1.
Anecdotally, upper truncal obesity and large breasts have often been associated with inferior outcomes from non-operative management of diaphyseal humerus fractures. However, this assertion is without basis in the literature.
To produce radiographic measurements of chest wall soft tissue thickness (STT) and determine association with non-union in diaphyseal humerus fractures.
Two hundred and seventeen consecutive non-operative humeral shaft fractures were included. Radiographic STT measurements were taken at three standardised points (upper, middle and lower) using a simple reproducible method, with ratios derived (dividing these figures by the mid-humerus diameter). Bivariate and multivariable analyses were used to assess association with non-union.
There were 58 (26.7%) cases of non-union. On multivariable analysis, the middle (odds ratio (OR) 1.39, p < 0.001) and lower (OR 1.23, p = 0.009) STT measurements were independently associated with non-union. Additionally, the middle (OR 1.85, p < 0.001) and lower (OR 1.47, p < 0.001) STT ratios were independently associated with non-union. A receiver operating characteristic curve determined a threshold value of a middle STT ratio of ≥ 3 (OR 3.73, p < 0.001, sensitivity 69.0%, specificity 62.3%), which was independently associated with non-union.
Chest wall STT is independently associated with humeral shaft non-union. Threshold values can assist in decision making for these fractures.
据传闻，上躯干肥胖和乳房较大常与肱骨干骨折非手术治疗效果较差有关。然而，这一说法在文献中并无依据。
对胸壁软组织厚度（STT）进行影像学测量，并确定其与肱骨干骨折不愈合的相关性。
纳入217例连续的非手术治疗肱骨干骨折患者。采用一种简单可重复的方法，在三个标准化点（上、中、下）进行影像学STT测量，并得出相应比值（将这些数值除以肱骨干中部直径）。采用双变量和多变量分析评估与不愈合的相关性。
有58例（26.7%）出现不愈合。多变量分析显示，中部（比值比（OR）1.39，p＜0.001）和下部（OR 1.23，p = 0.009）的STT测量值与不愈合独立相关。此外，中部（OR 1.85，p＜0.001）和下部（OR 1.47，p＜0.001）的STT比值与不愈合独立相关。通过绘制受试者工作特征曲线确定中部STT比值≥3为阈值（OR 3.73，p＜0.001，灵敏度69.0%，特异度62.3%），该阈值与不愈合独立相关。
胸壁STT与肱骨干骨折不愈合独立相关。阈值可辅助这些骨折的治疗决策。
