Héctor J Aguado1, Blanca Ariño2, Fernando Moreno-Mateo2, Elías Y Bustinza2, Clarisa Simón-Pérez3, Mario Martínez-Zarzuela4, Virginia García-Virto5, Paula S Ventura6, Miguel Ángel Martín-Ferrero7. 1. Orthopedic and Trauma Surgery (Trauma Unit), Hospital Clínico Universitario, Valladolid, Spain; Medical School, University of Valladolid, Valladolid, Spain. Electronic address: hjaguado@gmail.com. 2. Orthopedic and Trauma Surgery, Hospital Clínico Universitario, Valladolid, Spain. 3. Medical School, University of Valladolid, Valladolid, Spain; Orthopedic and Trauma Surgery (Upper Limb Unit), Hospital Clínico Universitario, Valladolid, Spain. 4. Telecoms Engineering School, Valladolid, Spain. 5. Orthopedic and Trauma Surgery (Trauma Unit), Hospital Clínico Universitario, Valladolid, Spain. 6. Hospital Clínico Universitario, Valladolid, Spain. 7. Medical School, University of Valladolid, Valladolid, Spain; Orthopedic and Trauma Surgery, Hospital Clínico Universitario, Valladolid, Spain.
Abstract
BACKGROUND: Nonoperative management of proximal humeral fractures (PHFs) is the most common treatment, but its functional outcome may improve with early mobilization. In frail osteoporotic patients, quick recovery of prefracture independency is mandatory. This study assessed fracture displacement in PHFs managed with conservative treatment after early mobilization and a home-based self-exercise program. METHODS: We retrospectively analyzed the radiologic displacement of fracture fragments of PHFs treated conservatively with early mobilization and a home-based self-exercise program. RESULTS: Included were 99 patients with 26 one-part, 32 two-part, 32 three-part, and 9 four-part PHFs managed conservatively, followed by early mobilization and a home-based self-exercise program. In the x-ray examinations, the head displaced from varus into valgus 55° ± 23° to 42° ± 22°, in the normal range of anatomic values. The medial hinge displaced from medial to the diaphysis (+1 ± 6 mm) to lateral to the head (-0.6 ± 6 mm). The greater tuberosity displaced cranially from -1 ± 7 mm to 2 ± 5 mm. The Constant score at the 1-year follow-up was 79.69 ± 16.3. DISCUSSION AND CONCLUSIONS: The home-based self-exercise program for conservative treatment of PHFs displaces the head-diaphysis angle and the medial hinge toward anatomic reduction, but there is a risk of greater tuberosity cranial displacement. Functional results are fairly good, allowing frail patients to keep on with their independency and life style. Because a large number of patients might need further physiotherapy, the quality of the home-based self-exercises should be supervised.
BACKGROUND: Nonoperative management of proximal humeral fractures (PHFs) is the most common treatment, but its functional outcome may improve with early mobilization. In frail osteoporoticpatients, quick recovery of prefracture independency is mandatory. This study assessed fracture displacement in PHFs managed with conservative treatment after early mobilization and a home-based self-exercise program. METHODS: We retrospectively analyzed the radiologic displacement of fracture fragments of PHFs treated conservatively with early mobilization and a home-based self-exercise program. RESULTS: Included were 99 patients with 26 one-part, 32 two-part, 32 three-part, and 9 four-part PHFs managed conservatively, followed by early mobilization and a home-based self-exercise program. In the x-ray examinations, the head displaced from varus into valgus 55° ± 23° to 42° ± 22°, in the normal range of anatomic values. The medial hinge displaced from medial to the diaphysis (+1 ± 6 mm) to lateral to the head (-0.6 ± 6 mm). The greater tuberosity displaced cranially from -1 ± 7 mm to 2 ± 5 mm. The Constant score at the 1-year follow-up was 79.69 ± 16.3. DISCUSSION AND CONCLUSIONS: The home-based self-exercise program for conservative treatment of PHFs displaces the head-diaphysis angle and the medial hinge toward anatomic reduction, but there is a risk of greater tuberosity cranial displacement. Functional results are fairly good, allowing frail patients to keep on with their independency and life style. Because a large number of patients might need further physiotherapy, the quality of the home-based self-exercises should be supervised.
Authors: Héctor J Aguado; Paula S Ventura-Wichner; Laura Perez-Hickman; Isabel Polo-Pérez; Juan A Alonso-Olmo; María Bragado; Adela Pereda-Manso; Mario Martínez-Zarzuela; Virginia García-Virto; Clarisa Simón-Pérez; Emilio J Barajas; Miguel A Martín-Ferrero Journal: Geriatr Orthop Surg Rehabil Date: 2021-08-26