Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 5 Issue 12

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.

Received: September 12, 2022; Published: November 07, 2022

Abstract

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

References

  1. Court-Brown CM and Caesar B. “Epidemiology of adult fractures : A review”. Injury 37 (2006): 6917.
  2. Majed A., et al. “Proximal humeral fracture classification systems revisited”. Journal of Shoulder and Elbow Surgery 7 (2011): 1125-1132.
  3. Widnall JC., et al. “Proximal humeral fractures: a review of current concepts”. The Open Orthopaedics Journal 7 (2013): 361-365.
  4. Gadea F., et al. “Osteosynthesis of fractures 4 fragments of the upper end of the humerus: are there radiological criteria in favor of osteosynthesis by nail or by locked screw plate? Retrospective comparative study aboutde 107 cases”. Revue de Chirurgie Orthopédique et Traumatologique8 (2016): 689-696.
  5. Gregory TM., et al. “Surgical treatment of three and four-part proximal humeral fractures”. Orthopaedics and Traumatology: Surgery and Research 1 (2013): S197-207.
  6. Gradl G., et al. “Is locking nailing of humeral head fractures superior to locking plate fixation?” Clinical Orthopaedics and Related Research 467 (2009): 2986-2993.
  7. Rothstock S., et al. “Biomechanical evaluation of two intramedullary nailing techniques with different locking options in a three-part fracture proximal humerus model”. Clinical Biomechanics 7 (2012): 686-691.
  8. Foruria AM., et al. “Proximal humerus fracture rotational stability after fixation using a locking plate or a fixed-angle locked nail: the role of implant stiffness”. Clinical Biomechanics 4 (2010): 307-311.
  9. Constant CR and Murley AHG. “A clinical method of functional assessment of the shoulder”. Clinical Orthopaedics and Related Research 214 (1987): 160-164.
  10. Boileau P., et al. “Reverse shoulder arthroplasty for acute fractures in the elderly: is it worth reattaching the tuberosities?” Journal of Shoulder and Elbow Surgery 3 (2019): 437-444.
  11. Jonsson EÖ., et al. Collaborators in the SAPF Study Group. “Reverse total shoulder arthroplasty provides better shoulder function than hemiarthroplasty for displaced 3- and 4-part proximal humeral fractures in patients aged 70 years or older: a multicenter randomized controlled trial”. Journal of Shoulder and Elbow Surgery 5 (2021): 994-1006.
  12. Hertel R., et al. “Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus”. Journal of Shoulder and Elbow Surgery 4 (2004): 427-433.
  13. Wong J., et al. “Outcomes of intramedulary nailing for acute proximal humerus fractures: a systematic review”. Journal of Orthopaedics and Traumatology 17 (2016): 113-122.
  14. Helfen T., et al. “Operative treatment of 2-part surgical neck fractures of the proximal humerus (AO 11-A3) in the elderly: Cement augmented locking plate PHILOSTM vs. proximal humerus nail MultiLoc”. BMC Musculoskeletal Disorders 17 (2016): 1-7.
  15. Ockert B., et al. “Long-term functional outcomes (median 10 years) after locked plating for displaced fractures of the proximal humerus”. Journal of Shoulder and Elbow Surgery 23 (2014): 1223-1231.
  16. Koval KJ., et al. “Functional outcome after minimally displaced fractures of the proximal part of the humerus”. The Journal of Bone and Joint Surgery. American 79 (1997): 203-207.
  17. Lander ST., et al. “Mortality Rates of Humerus Fractures in the Elderly: Does Surgical Treatment Matter?” Journal of Orthopaedic Trauma 7 (2019): 361-365.
  18. Melton LJ., et al. “Cost- equivalence of different osteoporotic fractures”. Osteoporosis International : A Journal Established as Result of Cooperation between the European Foundation USA5 (2003): 383-388.
  19. Lefevre-Colau MM., et al. “Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture. A randomized controlled trial”. The Journal of Bone and Joint Surgery. American 12 (2007): 2582-2590.
  20. Lädermann A., et al. “Functional recovery following early mobilization after middle third clavicle osteosynthesis for acute fractures or nonunion: A case-control study”. Orthopaedics and Traumatology: Surgery and Research 6 (2017): 885-889.
  21. Tirefort J., et al. “Postoperative Mobilization After Superior Rotator Cuff Repair: Sling Versus No Sling: A Randomized Prospective Study”. The Journal of Bone and Joint Surgery. American 6 (2019): 494-503.
  22. Koval KJ., et al. “Functional outcome after minimally displaced fractures of the proximal part of the humerus”. The Journal of Bone and Joint Surgery. American 2 (1997): 203-207.
  23. Caforio M and Maniscalco P. “The importance of early rehabilitation in proximal humeral fracture: A clinical trial of efficacy and safety of a new endomedullary nail”. Journal of Back and Musculoskeletal Rehabilitation 2 (2017): 195-202.
  24. Kloub M., et al. “Intramedullary nailing of displaced four-part fractures of the proximalhumerus”. Injury11 (2019): 1978-1985.

Citation

Citation: Maxime ANTONI., et al. “Is Early Mobilization a Viable Option after Intramedullary Nailing of 4-Parts Proximal Humerus Fractures?”. Acta Scientific Orthopaedics 5.12 (2022): 37-42.

Copyright

Copyright: © 2022 Maxime ANTONI., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate33%
Acceptance to publication20-30 days

Indexed In



News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is February 15, 2023.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US