Krammig Rike Herta, Mayor Jorge, Winkelmann Marcel, Oberthür Swantje, Sehmisch Stephan, Clausen Jan-Dierk
Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg Straße 1, 30625, Hannover, Deutschland.
Unfallchirurgie (Heidelb). 2025 Jul 25. doi: 10.1007/s00113-025-01603-9.
Humeral shaft fractures occur with an incidence of approximately 12-25 per 100,000 per year and exhibit two age peaks, young patients following high-energy trauma and older patients with low-energy trauma.
Principally, conservative treatment is a viable option, which requires high patient compliance but shows good healing rates in appropriate cases, particularly for fractures of the middle third of the shaft. Compared to surgical treatment there is a slightly increased rate of pseudarthrosis. In the case of surgical treatment, both plate osteosynthesis and intramedullary nailing show good results.
A distinction must be made between primary radial nerve injury, which occurs immediately after trauma and generally has good spontaneous recovery rates, and secondary radial nerve injury, which is a consequence of the initiated treatment. In this case, careful consideration should be given to the potential need for a surgical intervention.
Overall, both conservative and surgical treatment approaches lead to good functional outcomes in appropriately selected patients. The choice of treatment should be made individually, considering the patient's age, fracture complexity, comorbidities and expected patient compliance.
肱骨干骨折的发生率约为每年每10万人中有12 - 25例，呈现两个年龄高峰，一是高能创伤后的年轻患者，二是低能创伤后的老年患者。
原则上，保守治疗是一种可行的选择，这需要患者高度配合，但在适当的病例中愈合率良好，特别是对于肱骨干中1/3的骨折。与手术治疗相比，假关节形成率略有增加。在手术治疗的情况下，钢板内固定和髓内钉固定均显示出良好的效果。
必须区分原发性桡神经损伤和继发性桡神经损伤，原发性桡神经损伤发生在创伤后立即出现，通常有良好的自发恢复率，而继发性桡神经损伤是初始治疗的结果。在这种情况下，应仔细考虑是否可能需要进行手术干预。
总体而言，在适当选择的患者中，保守和手术治疗方法均可带来良好的功能结果。治疗方法的选择应因人而异，考虑患者的年龄、骨折复杂性、合并症以及预期的患者配合度。
