Functional outcomes after nonoperative management of fractures of the proximal humerus

Hanson, Beate; Neidenbach, Philipp; Boer, Piet de; Stengel, Dirk

doi:10.1016/j.jse.2009.03.024

Cited by 196 publications

(150 citation statements)

References 24 publications

(23 reference statements)

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“…While a few studies reported that non-operative management is associated with poor results [1,2], a recent prospective, but not controlled, trial found it difficult to demonstrate a significant advantage of surgical over non-operative management [3]. Consistent with the findings of the latter study is the observation that the results of various surgical treatments, such as closed reduction and percutaneous pinning [4,5], plate fixation [6,7] and hemiarthroplasty [8], may be unpredictable.…”

Section: Introductionmentioning

confidence: 83%

Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning

Carbone

Tangari

Gumina

et al. 2012

International Orthopaedics (SICOT)

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Purpose Elderly subjects often have fractures of the proximal humerus, which may be difficult to manage in patients in poor general condition. The MIROS is a new percutaneous pinning device allowing correction of angular displacement and stable fixation of fracture fragments. We evaluated the results of percutaneous fixation of three-or four-part fractures of the proximal humerus of patients in the American Society of Anesthesiologists physical status three or four treated either with MIROS or traditional percutaneous pinning (TPP). Methods A total of 31 patients treated with MIROS and 27 undergoing TPP were enrolled in the study. Pre-operatively anteroposterior and transthoracic or axillary radiographs were obtained in all cases and computed tomography scans in patients with the most complex fractures. Follow-up evaluations were carried out at three, six, 12 and 16 weeks, and six months, one year and two years postoperatively, using the Constant Score (CS) and subjective shoulder value (SSV) methods.Results Of the 58 patients, 52 could be evaluated at all follow-ups. In both three-or four-part fractures there were significantly higher CS and SSV scores in the MIROS compared to the TPP group at all the late follow-ups. Lower rates of deep infection, pin tract infection and pin mobilisation were found in the MIROS group (p<0.001). In both groups there was a significant association between the final result (CS) and either the type of fracture or complications (p<0.001). Conclusions The MIROS resulted in better clinical results and less complications than TPP in elderly patients. This method, however, may not be indicated for younger patients in good general condition.

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Section: Introductionmentioning

confidence: 83%

Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning

Carbone

Tangari

Gumina

et al. 2012

International Orthopaedics (SICOT)

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“…It is however concerning that additional testing such as the Michigan Hand Questionnaire 67 that was found responsive to report on activity and participation outcomes in tendon injuries, were used infrequently or not at all 22,23 . Measurement of the effects of an upper limb fracture should include a combination of assessments of body function and structure (range of motion and strength) and activity and participation (using self-report questionnaires such as the DASH 45 or Short Form-36 46 ) 37,40 . Some respondents used the DASH 45 with some frequency, but other measures of activity and participation indicated for this diagnostic group, such as the Short Form-36 46 , was used infrequently or not at all.…”

Section: Discussionmentioning

confidence: 99%

“…Such tools are in demand in South Africa as muscle, bone and peripheral nerves are among the most prominent structures injured and/or affected in hand conditions. Twenty-one articles 19,20,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] reporting 11 tools were identified. The tools were framed within the ICF (see Table1).…”

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confidence: 99%

Occupational therapy hand assessment practices: Cause for concern?

Klerk

Buchanan

Pretorius

2015

S. Afr. j. occup. ther

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Introduction: Assessment is critical for measuring improvement, or lack thereof, and demonstrating the outcome of intervention. In response to the lack of research in this area, this study aimed to determine the assessment practices of occupational therapists working with clients with hand conditions. Methods: A quantitative cross sectional survey design was used. A convenience sample of occupational therapists was recruited from five provinces. Respondents completed a questionnaire developed for the study that comprised demographic information, assessments used, frequency of use and factors influencing assessment choice. Data were analysed with Statistica version 11. Results: Eighty-one respondents (n=114) completed questionnaires representing a 71% response rate. Goniometry (84.0%), manual muscle testing (76.5%) and testing for flexor tendon function (76.3%) were used most frequently. The most common reasons for not using assessments were lack of availability and unfamiliarity. Conclusion: It is of concern that the assessment practices of participants in this study focussed primarily on the assessment of body function and structure with few therapists using activity and participation measures. This could seriously limit the evidence needed to verify the outcomes achieved through occupational therapy intervention in the treatment of hand conditions.evidence of the interventions provided 5 . If therapists do not assess, they will not be able to produce evidence of the effects of the interventions offered which poses a threat to funding of services. This claim is supported in the Western Cape Department of Health Healthcare 2030 plan 6 that states that there will be an increased move towards outcome based intervention with priority being given to interventions aimed at desirable outcomes. At the time of conducting this study, no research to determine the assessment practices of occupational therapists working with hand conditions within South Africa had been published. Assessment practices are understood to encompass the type of assessment used, the frequency of use and the reasons for non-use within a particular area of practice. This study therefore set out to provide an updated account of these practices by South African occupational therapists working with clients with hand conditions. LITERATURE REVIEWA client-centred approach should be applied in assessment to obtain a "careful understanding" of the individual before starting occupational therapy intervention 7:253 . This type of approach is more likely to ensure that the client is engaged in the occupational therapy process which will encourage greater client cooperation 8 . In a client-centred approach, the client and therapist work together to establish the occupational performance problems and to set goals for the required intervention. Assessment has to take place for this to be possible. Standardised assessment provides quantitative information, useful for tracking the client's progress and demonstrating the outcome of therapy 44United Kingdom the au...

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“…Although external stabilisation is simple and cheap, it is not easy to reduce the abducted fragment of the proximal fracture [9,10]. Absolute and relative indications for surgical treatment of proximal humeral shaft fractures have been documented in textbooks.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

Zhou

Gao

Tang

et al. 2012

International Orthopaedics (SICOT)

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Purpose The aim of this study was to evaluate clinical outcomes and complications following minimally invasive plate osteosynthesis (MIPO) with the proximal humeral internal locking system (PHILOS) for treating proximal humeral shaft fracture through the deltopectoral approach. Methods Between November 2008 and March 2010, 74 patients with unilateral proximal humeral shaft fractures were treated using the MIPO technique with the PHILOS through the deltopectoral approach. Patients received an average follow-up of 16.9 (range, 12-24) months, and the final follow-up included anteroposterior and lateral imaging and recording of postoperative complications. The Constant-Murley shoulder score was used to evaluate function. Results No intraoperative complications occurred. Postoperative complications included subacromial impingement in four patients. There was no deep infection, neurovascular damage, breakage or implant loosening. All fractures united in an average time of 17.4 (15-25) weeks. In terms of function, the Constant-Murley score was 85.8 points on average (range, 67-100). The range of motion of the involved shoulder was satisfactory, and pain-free in 83.8 % of patients. Conclusions Using the MIPO technique with the PHILOS through the deltopectoral approach is a valid and safe method of treating proximal humeral shaft fractures.

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Functional outcomes after nonoperative management of fractures of the proximal humerus

Cited by 196 publications

References 24 publications

Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning

Percutaneous pinning of three- or four-part fractures of the proximal humerus in elderly patients in poor general condition: MIROS® versus traditional pinning

Occupational therapy hand assessment practices: Cause for concern?

Minimally invasive percutaneous osteosynthesis for proximal humeral shaft fractures with the PHILOS through the deltopectoral approach

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