Is Early Mobilization a Viable Option after Intramedullary Nailing of 4-Parts
Proximal Humerus Fractures?
Florent BALDAIRON, Maxime ANTONI*, Vinh LE THAI And Philippe CLAVERT
Department of Surgery of the Upper Limb Hospital of Hautepierre 2, France
*Corresponding Author: Maxime ANTONI, Department of Surgery of the Upper Limb Hospital of Hautepierre 2, France.
September 12, 2022; Published: November 07, 2022
Introduction: After Centro medullary nailing (ECM) of 4-fragment (4P) cephalo-tuberositary fractures of the upper end of the humerus (ESH), the implementation of shoulder immobilization is usual, although no scientific justification does not support this attitude, nor the duration of immobilization.
The objective of this study was to assess the impact of immobilization time after ECM of ESH 4P fractures on clinical, radiological outcomes and complication rates. The hypothesis was that early mobilization would not be accompanied by a deterioration in results or an increase in the complication rate.
Materials and Methods: All patients operated on for a 4P fracture of ESH by ECM in our center between 2010 and 2018 were included retrospectively. 2 groups were formed according to the duration of post-operative immobilization of the shoulder: 0 to 2 weeks (group A) and 3 to 6 weeks (group B). All had a clinical examination (amplitudes and Constant score) and x-rays of the shoulder at least 24 months of hindsight. 58 patients of average age 66 years (39-98) were included, including 25 in group A and 33 in group B.
Results: The average decline was 38.5 (24-73) months. The active joint amplitudes at the last setback were: active anterior elevation 149° (80-180°) in group A versus 134 (60- 180°) in group B (p = 0.099); active external rotation elbow to the body 45° (15-70°) in group A versus 42° (15-70°) in group B (p = 0.6). The Absolute Mean Constant score was 78.29 for Group A (45-100) versus 68.59 points (45-96) for Group B (p = 0.0065). Regarding complications, in group A, we found 2 retractile capsulitis, 2 pseudarthrosis and 2 osteonecrosis of the humeral head. In the group B, we found 5 retractile capsulitis, 1 infection of the surgical site, 3 osteonecrosis of the humeral head and 1 pseudarthrosis.
Conclusions: Early shoulder mobilization after ECM of ESH 4P fractures had no impact on clinical or radiological outcomes, complication or displacement rates secondary.
Evidence Level: IV, retrospective study.
Keywords: Humerus Fracture; Cephalo-Tuberositary; Centromedullary Nailing; Immobilization
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