Izawa Yuta, Futamura Kentaro, Nishida Masahiro, Murakami Hiroko, Sato Kazuo, Tsuchida Yoshihiko
Shonan Kamakura General Hospital, Kamakura, Japan.
Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.
Arch Orthop Trauma Surg. 2025 May 15;145(1):296. doi: 10.1007/s00402-025-05915-8.
In humeral shaft fractures, the presence of a free bone fragment, called the third fragment or butterfly fragment, is thought to induce non-union. We hypothesised that non-union and subsequent reoperations could be reduced by performing cerclage wiring for fragments, in addition to intramedullary nailing for fractures with the third fragment. This study aimed to examine the effectiveness of cerclage wiring for the third fragments associated with humeral shaft fractures.
This study included patients with humeral shaft fractures involving the third fragment, who underwent osteosynthesis with intramedullary nailing at our institution between April 2013 and June 2024. The patients were divided into two groups: those who underwent osteosynthesis using an intramedullary nail alone (Group1) and those who underwent osteosynthesis using an intramedullary nail with cerclage wiring (Group2). Patient and injury characteristics, surgical time, intraoperative blood loss, postoperative complications, fracture healing, time to bone union, and reoperation were investigated and compared between the two groups.
Sixteen patients were included in Group1 and 27 patients were included in Group2. There were no significant differences in patient characteristics or injuries. Surgical time was significantly longer (p = 0.01) and intraoperative blood loss was significantly greater (p = 0.01) in Group2. There were no significant differences in the rates of infection and postoperative nerve paralysis (p = 1, 0.522). The rates in non-union was significantly higher in Group1 (p = 0.05). There were no significant differences in reoperation rate (p = 0.137). In cases where fracture healing was achieved, the time to bone union was significantly longer in Group1 (p < 0.001).
Cerclage wiring, in addition to intramedullary nailing for fractures with a third fragment, may prevent non-union. Although the addition of cerclage wiring significantly increased the surgical time and intraoperative blood loss, there was no increase in postoperative complications.
在肱骨干骨折中，存在一个游离骨块，即所谓的第三骨块或蝶形骨块，被认为会导致骨不连。我们假设，对于伴有第三骨块的骨折，除了进行髓内钉固定外，对骨块进行环扎钢丝固定可以减少骨不连及后续再次手术的发生。本研究旨在探讨环扎钢丝固定对伴有肱骨干骨折的第三骨块的有效性。
本研究纳入了2013年4月至2024年6月期间在我院接受髓内钉固定治疗的伴有第三骨块的肱骨干骨折患者。患者被分为两组：仅使用髓内钉进行骨固定的患者（第1组）和使用髓内钉并进行环扎钢丝固定的患者（第2组）。对两组患者的患者及损伤特征、手术时间、术中出血量、术后并发症、骨折愈合情况、骨愈合时间及再次手术情况进行了调查和比较。
第1组纳入16例患者，第2组纳入27例患者。患者特征及损伤情况无显著差异。第2组的手术时间显著更长（p = 0.01），术中出血量显著更多（p = 0.01）。感染率和术后神经麻痹发生率无显著差异（p = 1, 0.522）。第1组的骨不连发生率显著更高（p = 0.05）。再次手术率无显著差异（p = 0.137）。在骨折愈合的病例中，第1组的骨愈合时间显著更长（p < 0.001）。
对于伴有第三骨块的骨折，除了髓内钉固定外，环扎钢丝固定可能预防骨不连。虽然增加环扎钢丝固定显著延长了手术时间和术中出血量，但术后并发症并未增加。
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