Does an early mobilization and immediate home-based self-therapy exercise program displace proximal humeral fractures in conservative treatment? Observational study

Hernández, Héctor J.; Ariño, Blanca; Moreno-Mateo, Fernando; Bustinza, Elías Y.; Simón-Pérez, Clarisa; Martínez‐Zarzuela, Mario; García-Virto, Virginia; Ventura, Paula Sol; Martín-Ferrero, Miguel Ángel

doi:10.1016/j.jse.2018.04.001

Cited by 14 publications

(16 citation statements)

References 32 publications

(38 reference statements)

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“…Little attention has been given to factors within the postoperative period that might improve results of fracture repair. Some studies have researched mobilization protocols following non-operative management of proximal humerus fractures [7][8][9]. Fewer studies have looked at the effect of postoperative arm position following fracture fixation in the shoulder.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical investigation of arm position on deforming muscular forces in proximal humerus fractures

Chalmers

Wright

Patel

et al. 2022

Clin Shoulder Elbow

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Background: Muscular forces drive proximal humeral fracture deformity, yet it is unknown if arm position can help mitigate such forces. Our hypothesis was that glenohumeral abduction and humeral internal rotation decrease the pull of the supraspinatus and subscapularis muscles, minimizing varus fracture deformity.Methods: A medial wedge osteotomy was performed in eight cadaveric shoulders to simulate a two-part fracture. The specimens were tested on a custom shoulder testing system. Humeral head varus was measured following physiologic muscle loading at neutral and 20° humeral internal rotation at both 0° and 20° glenohumeral abduction. Results: There was a significant decrease in varus deformity caused by the subscapularis (p<0.05) at 20° abduction. Significantly increasing humeral internal rotation decreased varus deformity caused by the subscapularis (p<0.05) at both abduction angles and that caused by the supraspinatus (p<0.05) and infraspinatus (p<0.05) at 0° abduction only.Conclusions: Postoperative shoulder abduction and internal rotation can be protective against varus failure following proximal humeral fracture fixation as these positions decrease tension on the supraspinatus and subscapularis muscles. Use of a resting sling that places the shoulder in this position should be considered.

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Section: Discussionmentioning

confidence: 99%

Biomechanical investigation of arm position on deforming muscular forces in proximal humerus fractures

Chalmers

Wright

Patel

et al. 2022

Clin Shoulder Elbow

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“…And we know from a previous study that early mobilization does not displace PHF. 29 This HBRP does not prescribe a certain number of repetitions, or timing, or number of training sessions: we encourage to exercise daily in multiple short sessions, with only 1 longer exercise session per day, and keep as independent as possible for BADL from the first day. Besides, the tools are not “fancy”: easy content with simple instructions in plain language.…”

Section: Discussionmentioning

confidence: 99%

“…At that time (January 2015), patients did not receive any document explaining the exercises, except for verbal explanations, and all patients received standard physiotherapy. Because the results of that study were promising, 29 we took a step forward to improve this treatment. We produced an early mobilization HBRP with specific documental tools.…”

Section: Methodsmentioning

confidence: 99%

Patient Satisfaction Using a Home-Based Rehabilitation Protocol for the Non-Surgical Treatment of Proximal Humeral Fractures: A Prospective Longitudinal Cohort Study

Hernández

Wichner

Pérez-Hickman

et al. 2021

Geriatr Orthop Surg Rehabil

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Supervised, center-based, daily physiotherapy presents limitations: transport, need for an accompanying person, or risk of infection. Home-based rehabilitation protocols (HBRP) can be effective alternatives. We use a HBRP for the non-surgically treated proximal humeral fractures (PHF) in older patients. Objectives To assess patient satisfaction and preferences of using a booklet, videos, or an app to guide physiotherapy. Patients and methods Prospective, single-center observational study of patients ≥55 years old who sustained a non-surgically treated PHF. The HBRP consisted of immediate mobilization, followed by 5 physiotherapist-guided, weekly sessions of rehabilitation and standard physiotherapy after 3 months, if needed. A booklet with images, videos, or a smartphone application were offered to guide the patients. Results Mean degree of satisfaction (1-5) was 4.66 ± .9: 84 patients (82.4%) were very satisfied, 11 patients (10.8%) were satisfied, and 5 patients (4.9%) were not satisfied at all. Mean Oxford Shoulder Score achieved was 40.5 ± 6.6. 59.8% patients preferred the booklet and 29.4% the videos. Exercise compliance was considered very high in 87.3% of patients, while 4% hardly never followed the HBRP. Only 17.7% patients needed center-based physiotherapy after the HBRP. Discussion Reasons for satisfaction were good final functional outcome, no need for transportation, being away from hospital, immediate rehabilitation availability and being capable of maintaining independence. Adherence is a major concern. Videos are more didactic explaining the exercises. Conclusion If standard physiotherapy is not available, the HBRP can be a valid treatment option for PHF management in older patients, with a high degree of patient satisfaction. Older patients preferred the booklet to guide physiotherapy.

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Section: Grundprinzipien Der Konservativen Behandlung Proximaler Hume...unclassified

“…Einige Autoren wiesen zudem auf ein anderes, bisher seltener thematisiertes Phänomen hin, dass beispielsweise eine dislozierte 4-Part-Fraktur nach Neer nur eine Woche später spontan als gering dislozierte 1-Part-Fraktur in Erscheinung tritt [15,16]. Eine der ältesten Hypothesen besagt, dass für dieses Selbstkorrekturpotential die Schwerkraft eine treibende Kraft sei [9,15]. DePalma und Cautilli [10] und andere stellten schon vor Jahrzehnten die Hypothese auf, dass das Eigengewicht des betroffenen Arms von etwa 4-7kg in vielen Fällen ausreichend sei, um die meisten Frakturen zu korrigieren [9].…”

Section: Grundprinzipien Der Konservativen Behandlung Proximaler Hume...unclassified

Algorithmus zur konservativen Behandlung von proximalen Humerusfrakturen

2022

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ZusammenfassungDie proximale Humerusfraktur ist eine häufige Verletzung mit steigender Inzidenz. Die aktuelle S1-Leitlinie „Oberarmkopffraktur“ der federführenden Deutschen Gesellschaft für Unfallchirurgie e. V. (DGU) hält zwar fest, dass ein Großteil dieser Frakturen konservativ behandelt werden kann. Es stellt sich jedoch die Frage, wie genau sich jene konservative Therapie gestalten lässt. Nationale wie internationale Unterschiede in der Therapie unterstreichen ein uneinheitliches Management und den fehlenden Konsens in der Behandlung dieser so häufigen Verletzung. Im folgenden Artikel soll ein Einblick in die Erfahrungen der Autoren gewährt und eine mögliche alltagstaugliche Entscheidungshilfe vorgestellt werden, mit welcher diese stetig zunehmende Verletzungsart erfolgreich konservativ behandelt werden kann. Die Erfahrungen stützen sich dabei auf einen Patientenstrom von jährlich mehr als 200 Patienten eines Level-1-Traumazentrumes, von denen zwischen 01/2016 bis 09/2021 jährlich ca. 80 % erfolgreich einer konservativen Therapie zugeführt werden konnten und im Rahmen einer prospektiven Observationsstudie, dem Hannover Humerusregister (ClinicalTrials.gov Identifier: NCT03060876), systematisch nachkontrolliert wurden.

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Does an early mobilization and immediate home-based self-therapy exercise program displace proximal humeral fractures in conservative treatment? Observational study

Cited by 14 publications

References 32 publications

Biomechanical investigation of arm position on deforming muscular forces in proximal humerus fractures

Biomechanical investigation of arm position on deforming muscular forces in proximal humerus fractures

Patient Satisfaction Using a Home-Based Rehabilitation Protocol for the Non-Surgical Treatment of Proximal Humeral Fractures: A Prospective Longitudinal Cohort Study

Algorithmus zur konservativen Behandlung von proximalen Humerusfrakturen

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