■肱骨干骨折是骨科医生治疗的常见损伤。这项研究的目的是评估移位的肱骨干骨干骨折,并描述与非移位或最小移位的骨折线延伸到肱骨近端干骨干区域的发生率和特征。
■所有肱骨干骨干骨折位于肱骨干远端三分之二的成人患者,在2007年至2020年期间在单一一级创伤机构接受治疗,进行了回顾性鉴定。包括202例肱骨干骨折203例。根据AO/OTA分类对骨折类型进行分类,并在X线片上评估骨折线延伸到近端骨干处区域。患者人口统计学,管理细节,和影像学结果来自电子病历的审查.
■203例肱骨干骨干骨折,11.8%(n=24)的主要骨折线未移位或移位最小。这包括所有近端第三交界骨干骨干骨折的43.7%(n=7),10.7%(n=16)的所有中段骨干骨折,和所有远端第三骨干骨折的2.6%(n=1)。近端骨折延伸的患者,平均而言,老年人(61.7岁对44.4岁,p<0.001),女性比例更高(75%对45.5%,p<0.01)与无骨折近端延伸的患者相比。近端延伸骨折均为闭合性骨折(n=24),更常见的是低能量下降(87.5%对35.2%,p<0.001),更常见的是螺旋型骨折(62.5%对17.2%)。近端延伸骨折更常非手术治疗(58.3%对42.1%,p<0.01),但发现非手术治疗后的骨不连发生率(17.6%对8.1%)高于没有近端延伸的骨折.所有经手术治疗的近端干phy端延伸骨折均用固定结构固定,以实现近端骨折线范围的固定。最常进入肱骨头和颈部。对于骨不连的患者,还进行了肱骨头近端固定的手术管理,包括近端延伸线的持续透明度,在非手术治疗失败后。平均随访时间为35.5周(范围:0-607周)。
■在肱骨干骨干骨折的情况下,近端骨折线延长并不少见。在计划手术治疗这些损伤时,检测和考虑这种有时微妙的发现很重要。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.