Does Surgery Improve Healing After Isolated Diaphyseal Ulna Fractures?

Autor:	Henry TW; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA., McEntee RM; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA., Matzon JL; Rothman Orthopaedic Institute, Philadelphia, PA., Lutsky KF; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA; Rothman Orthopaedic Institute, Philadelphia, PA; University of Vermont Medical Center, Burlington, VT. Electronic address: kevin.lutsky@uvmhealth.org.
Jazyk:	angličtina
Zdroj:	The Journal of hand surgery [J Hand Surg Am] 2023 Aug; Vol. 48 (8), pp. 834.e1-834.e7. Date of Electronic Publication: 2022 Apr 22.
DOI:	10.1016/j.jhsa.2022.02.009
Abstrakt:	Purpose: Isolated diaphyseal ulna fractures can be treated nonsurgically or with open reduction and internal fixation (ORIF). It is unclear whether ORIF provides quicker and/or more predictable healing. The purpose of this study was to compare the healing characteristics of isolated diaphyseal ulna fractures after surgical and nonsurgical treatment. Methods: All patients treated for an isolated diaphyseal (distal- or middle-third) ulna fracture between 2010 and 2018, with a minimum of 3 months of follow-up, were identified. Electronic medical records were reviewed to record patient demographics, assess the treatments used, and compare outcomes. We determined healing and nonunion rates, complications, reoperations, and final radiographic fracture alignment. Results: Ninety-five patients were included with a median follow-up of 20 weeks. Of these, 56 patients were treated nonsurgically and 39 patients were treated with ORIF. At the time of the final follow-up, 51 of the 56 (91.1%) nonsurgically treated fractures had healed and 38 of the 39 (97.4%) surgically managed fractures had healed. There were 5 nonunions after nonsurgical treatment (8.9%) and 1 nonunion after ORIF (2.6%). Eleven patients (19.6%) treated nonsurgically required conversion to ORIF, whereas 4 patients (10.3%) treated with ORIF required reoperation. Middle-third fractures treated nonsurgically had a higher rate of nonunion (30.8%) compared with distal-third fractures treated nonsurgically (2.3%). Conclusions: The healing characteristics of isolated ulnar shaft fractures do not appear to differ substantially between surgical and nonsurgical treatment. However, nearly 20% of the patients treated nonsurgically may require eventual ORIF. Distal-third fractures may be at a higher risk of conversion to ORIF, and middle-third fractures may be at a higher risk of nonunion. Type of Study/level of Evidence: Therapeutic IV. (Copyright © 2023 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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