Tendencias actuales del tratamiento de las fracturas diafisarias de húmero
Palabras clave:
fractura, diáfisis, húmero, tratamiento conservadorResumen
Las fracturas de la diáfisis humeral constituyen entre el 1 y el 3 % de los traumas atendidos en urgencias. El tratamiento ha evolucionado, y en la actualidad se emplea tanto el manejo quirúrgico como el no quirúrgico. Este artículo se propuso revisar las tendencias relacionadas con el tratamiento conservador de las fracturas de la diáfisis del húmero. El tratamiento conservador proporciona ventajas sobre la cirugía, disminuye el riesgo de infección profunda y la parálisis del nervio radial. Se ha reconocido la eficacia de los procedimientos conservadores en las fracturas de la diáfisis del húmero, a través de sus resultados funcionales y las tasas de consolidación en el 80 % de los pacientes. Se utilizan varios métodos para la inmovilización como el vendaje Velpeau, la férula en U, el yeso colgante y el aparato ortopédico.
Descargas
Citas
1. Brorson S. Management of fractures of the humerus in Ancient Egypt, Greece, and Rome: An historical review. Clin Orthop Relat Res. 2009;467(7):1907-14. DOI: https://doi.org/10.1007/s11999-008-0612-x
2. Caldwell JA. Treatment of fractures in the cincinnati general hospital. Ann Surg. 1933;97(2):161-76. DOI: https://doi.org/10.1097/00000658-193302000-00001
3. Bergdahl C, Ekholm C, Wennergren D, Nilsson F, Moller M. Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: data from the Swedish Fracture Register. BMC Musculoskelet Disord. 2016;17(1):159. DOI: https://doi.org/10.1186/s12891-016-1009-8
4. Westrick E, Hamilton B, Toogood P, Henley B, Firoozabadi R. Humeral shaft fractures: results of operative and non-operative treatment. Int Orthop. 2017;41(2):385-95. DOI: https://doi.org/10.1007/s00264-016-3210-7
5. Biber R, Bail HJ, Geßlein M. Humeral shaft fractures. Unfallchirurg. 2018;121(9):747-58. DOI: https://doi.org/10.1007/s00113-018-0533-4
6. Cambon-Binder A, Féron JM, Gaillard J. Tratamiento quirúrgico de las fracturas de la diáfisis humeral del adulto. EMC - Téc Quirúrg Ortop Traumatol. 2023;15(1):1-19. DOI: https://doi.org/10.1016/S2211-033X(23)47453-1
7. Pidhorz L. Acute and chronic humeral shaft fractures in adults. Orthop Traumatol Surg Res. 2015;101(1 suppl):S41-9. DOI: https://doi.org/10.1016/j.otsr.2014.07.034
8. Meinberg Eg, Agel J, Roberts Cs, Karam Md, Kellam Jf. Fracture and dislocation classification compendium-2018. J Orthop Trauma. 2018;32 suppl 1:S1-170. DOI: https://doi.org/10.1097/bot.0000000000001063
9. Ekholm R, Ponzer S, Tornkvist H, Adami J, Tidermark J. The Holstein-Lewis humeral shaft fracture: aspects of radial nerve injury, primary treatment, and outcome. J Orthop Trauma. 2008;22(10):693-7. DOI: https://doi.org/10.1097/bot.0b013e31818915bf
10. Stewart SK. Fracture non-union: a review of clinical challenges and future research needs. Malays Orthop J. 2019;13(2):1-10 DOI: https://doi.org/10.5704/moj.1907.001
11. Moore EE, Feliciano DV, Mattox KL. Trauma. 8 ed. McGraw-Hill Medical; 2017. 12. Boer FC, Patka P, Bakker FC, Haarman HJTM. Current concepts of fracture healing, delayed unions, and nonunions. Osteosynth Trauma Care. 2021;10(1):1-7. DOI: https://doi.org/10.1055/s-2002-30627
13. Mahabier KC, Van Lieshout EM, Bolhuis HW, Koen P, Bronkhorst M, Bruijninckx M, et al. Humeral shaft fractures: Measuring recovery after operative versus non-operative treatment (HUMMER): A multicenter comparative observational study. BMC Musculoskelet Disord. 2014;15(1):39. DOI: https://doi.org/10.1186/1471-2474-15-39
14. Denard A Jr, Richards JE, Obremskey WT, Tucker MC, Floyd M, Herzog GA. Outcome of nonoperative vs operative treatment of humeral shaft fractures: A retrospective study of 213 patients. Orthoped. 2020;33(8). DOI: https://doi.org/10.3928/01477447-20100625-16
15. Sarmiento A, Kinman PB, Galvin EG, Schmitt RH, Phillips JG. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg Am. 1977 [acceso 26/08/2022];59(5):596-601. Disponible en: https://pubmed.ncbi.nlm.nih.gov/873955/
16. Andrzejowski P, Giannoudis P. The ‘diamond concept’ for long bone non-union management. J Orthop Traumatol. 2019;20:21. DOI: https://doi.org/10.1186/s10195-019-0528-0
17. Schneider P, Bergeron S, Liew A. A randomized controlled trial comparing operative and nonoperative treatment of humeral diaphyseal fractures. Orthop Procs. 2022;104-B(suppl 13):77-77. DOI: https://doi.org/10.1302/1358-992X.2022.13.077
18. Hodgsona H, Giannoudis P, Howard A. Fracture non-union; what are the current perceived challenges among clinicians? Injury. 2022;53(12):3865-6. DOI: https://doi.org/10.1016/j.injury.2022.10.029
19. Rellan I, Galluci GL, Donndorff AG, De Carli P, Zaidenberg EE, Richard MJ, et al. Time until union in absolute vs. relative stability MIPO plating in simple humeral shaft fractures. Eur J Orthop Surg Traumatol. 2022;32(1):191-7. DOI: https://doi.org/10.1007/s00590-021-02920-6
20. Pehlivan O. Functional treatment of the distal third humeral shaft fractures. Arch Orthop Trauma Surg. 2022;122(7):390-5. DOI: https://doi.org/10.1007/s00402-002-0403-x
21. Karimi D, Houkjaer L, Skive A, Holmenlund C, Brorson S, Viberg B, et al. Exploring patient experiences after treatment of humeral shaft fractures: a qualitative study. Int J Orthopaedic Trauma Nursing. 2022;46:100957. DOI: https://doi.org/10.1016/j.ijotn.2022.100957
22. Updegrove GF, Mourad W, Abboud JA. Humeral shaft fractures. J Shoulder Elbow Surg. 2018;27:e87-97. DOI: https://doi.org/10.1016/j.jse.2017.10.028
23. Shields E, Sundem L, Childs S, Maceroli M, Humphrey C, Ketz JP, et al. The impact of residual angulation on patient reported functional outcome scores after non-operative treatment for humeral shaft fractures. Injury. 2016;47(4):914-8. DOI: https://doi.org/10.1016/j.injury.2015.12.014
24. Pollock FH, Maurer JP, Sop A, Callegai J, Broce M, Kali M, et al. Humeral shaft fracture healing rates in older patients. Orthoped. 2020;43:168-72. DOI: https://doi.org/10.3928/01477447-20200213-03
25. Lode I, Nordviste V, Erichsen JL, Schmal H, Viberg B. Operative versus nonoperative treatment of humeral shaft fractures: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2020;29(12):2495-2504. DOI: https://doi.org/10.1016/j.jse.2020.05.030
26. Oliver WM, Bell KR, Molyneux SG, White TO, Clement ND, Duckworth AD, et al. Surgical versus nonsurgical management of humeral shaft fractures: a systematic review and meta-analysis of randomized trials. J Am Acad Orthop Surg. 2023;31(2):e82-93. DOI: https://doi.org/10.5435/jaaos-d-22-00432
27. van de Wall BJM, Ochen Y, Beeres FJP, Babst R, Link B, Heng M, et al. Conservative vs. operative treatment for humeral shaft fractures: a meta-analysis and systematic review of randomized clinical trials and observational studies. J Shoulder Elbow Surg. 2020;29(7):1493-504. DOI: https://doi.org/10.1016/j.jse.2020.01.072
28. Driesman AS, Fisher N, Karia R, Konda S, Egol KA. Fracture site mobility at 6 weeks after humeral shaft fracture predicts nonunion without surgery. J Orthop Trauma. 2017;31(12):657-62. DOI: https://doi.org/10.1097/bot.0000000000000960
29. Rämö L, Sumrein BO, Lepola V, Lähdeoja T, Ranstam J, Paavola M, et al. Effect of surgery vs functional bracing on functional outcome among patients with closed displaced humeral shaft fractures: the FISH randomized clinical trial. JAMA. 2020;323(18):1792-1801. DOI: https://doi.org/10.1001/jama.2020.3182
30. Serrano R, Mir H, Sagi H, Horwitz D, Ketz J, Kistler B, et al. Modern results of functional bracing of humeral shaft fractures: a multicenter retrospective analysis. J Orthop Trauma. 2020;34(4):206-9. DOI: http://dx.doi.org/10.1097/BOT.0000000000001666
31. Den Hartog D, Van Bergen SH, Mahabier KC, Verhofstad MHJ, Van Lieshout EMM, HUMMER Investigators. Functional and clinical outcome after operative versus nonoperative treatment of a humeral shaft fracture (HUMMER): results of a multicenter prospective cohort study. Eur J Trauma Emerg Surg. 2022;48(4):3265e3277. DOI: https://doi.org/10.1007/s00068-022-01890-6
32. Ali E, Griffiths D, Obi N, Tytherleigh-Strong G, Van Rensburg L. Nonoperative treatment of humeral shaft fractures revisited. J Shoulder Elbow Surg. 2015;24(2):210-4. DOI: http://dx.doi.org/10.1016/j.jse.2014.05.009
33. Entezari V, Olson JJ, Vallier HA. Predictors of traumatic nerve injury and nerve recovery following humeral shaft fracture. J Shoulder Elbow Surg. 2021;30(12):2711-9. DOI: https://doi.org/10.1016/j.jse.2021.04.025
34. Harkin FE, Large RJ. Humeral shaft fractures: Union outcomes in a large cohort. J Shoulder Elbow Surg. 2017;26(11):1881-8. DOI: http://dx.doi.org/10.1016/j.jse.2017.07.001
35. Hendrickx LAM, Hilgersom NFJ, Alkaduhimi H, Doornberg JN, van den Bekerom MPJ. Radial nerve palsy associated with closed humeral shaft fractures: a systematic review of 1758 patients. Arch Orthop Trauma Surg. 2021;141(4):561-8. DOI: https://doi.org/10.1007/s00402-020-03446-y
36. Hegeman EM, Polmear M, Scanaliato JP, Nesti L, Dunn JC. Incidence and management of radial nerve palsies in humeral shaft fractures: a systematic review. Cureus. 2020;12(11):e11490. DOI: https://doi.org/10.7759/cureus.11490
37. Koch P, Gross D, Gerber C. The results of functional (Sarmiento) bracing of humeral shaft fractures. J Shoulder Elbow Surg. 2002;11(2):143-50. DOI: https://doi.org/10.1067/mse.2002.121634
38. Orapiriyakula W, Apivatthakakul V, Theppariyapol B, Apivatthakakul T. Humerus shaft fractures, approaches and management. J Clin Orthop Trauma. 2023;43:102230. DOI: https://doi.org/10.1016/j.jcot.2023.102230
39. Matsunaga F, Tamaoki MJ, Matsumoto MH, Netto N, Faloppa F, Belloti JC. Minimally invasive osteosynthesis with a bridge plate versus a functional brace for humeral shaft fractures: a randomized controlled trial. J Bone Joint Surg Am. 2017;99(7):583-92. DOI: https://doi.org/10.2106/jbjs.16.00628
40. Gallusser N, Barimani B, Vauclair F. Humeral shaft fractures. EFORT Open Rev. 2021;6(1):24-34. DOI: https://doi.org/10.1302/2058-5241.6.200033
41. Smith J, Hall J, Buckley R. Midshaft humeral fracture-Operative or nonoperative treatment? Injury. 2023;54(12):111142. DOI: https://doi.org/10.1016/j.injury.2023.111142
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2025 Horacio Inocencio Tabares Neyra, Horacio Tabares Sáez, Jesús Humberto Ramírez Espinoza, Roberto Morales Seife

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.