Rehabilitation after two-part fractures of the neck of the humerus

Hodgson, Stephen; Mawson, Sue; Stanley, David

doi:10.1302/0301-620x.85b3.13458

Cited by 88 publications

(59 citation statements)

References 30 publications

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“…To overcome this problem, early mobilization is mandatory and that is not possible in conservative treatment before three weeks. [12][13][14] Restriction in range of movements in conservative group is due to increased bursal and capsular adhesions. 15 The early mobilization could be achieved by the use of external fixator (JESS) which allows shoulder mobilization within one week.…”

Section: Discussionmentioning

confidence: 99%

Functional outcome following external fixator (JESS) application for proximal humeral fractures

et al. 2016

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Background: Proximal humeral fractures account for 5% of all fractures. Observed frequently in older osteoporotic patients but found in young patients with high-energy trauma.About 80% of these fractures are undisplaced or minimally displaced. Non-operative method requiring immobilization of shoulder often leads to a stiff shoulder, whereas surgical procedures such as plating need excessive soft tissue dissection. It was overcome in this study by less soft tissue dissection by use of external fixator application and early mobilization.Methods: Total of 18 patients mean age 40.5 years, predominantly male (16/18) treated with external fixator - JESS (Joshi’s external immobilization system) for Neer’s two, three and four part proximal humeral fractures. Vehicular accidents were the most common mode of injury followed by fall. There were 8 cases each of Neer's two and three part fractures. Shoulder mobilization started within a week as postoperativelyas pain allowed. Patients followed up at 3, 6, 12 and 18 weeks for pain, function, range of motion and anatomy with check X-ray. After radiological union at 8-10 weeks JESS was removed. Cases were evaluated for functional result by constant scoring system.Results: Average score on constant scoring system was 72 after a mean follow-up of 6 months. All fractures united in mean duration of 9.33 weeks. The complications included shoulder stiffness in one case and pin tract infection in two cases.Conclusions: Early shoulder mobilization a prerequisite for good results can be achieved without compromising fracture union. Less soft tissue dissection required and significant cost effective.

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Section: Discussionmentioning

confidence: 99%

Functional outcome following external fixator (JESS) application for proximal humeral fractures

et al. 2016

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“…Thus each procedure is has some limitations and complications. A major disadvantage of non-operative treatment is failure to obtain early mobilization, which results in a high rate of shoulder stiffness and pain, and mansion or nonunion is likely with certain fracture types [9][10][11] . The purpose of this study was to evaluate the functional outcome of a modification of percutaneous K-wire fixation technique.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of functional outcomes of a modified technique for percutaneous pinning of proximal humeus fracture

Kelkar¹,

Mundra²

2018

Int. J. Orthop. Sci.

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Introduction: Proximal humeral fractures are extremely common injuries, and are one of the true osteoporotic fractures. For those that have moderate to severe displacement, the optimal treatment for the patient has not been fully elucidated. The purpose of this study was to evaluate the functional outcome of a modification of percutaneous K-wire fixation technique. Material and methods: A prospective study was performed on all patients diagnosed with intra-articular proximal humerus fracture presenting to us from June 2013 to June 2016. Only patients with closed, displaced two or three part fractures as per Neer's classification were included in the study. Fractures were managed by close reduction and percutaneous pinning with K wires which were linked by a fixator rod using clamps. Patients were evaluated for functional outcome using the Constant score. Results: Twenty seven patients comprising of 18 females and 9 males were followed for an average period of 14 months. Mean age of the patients was 56 years. Fall while walking was the most common mode of injury followed. Mean Constant Score of patients was 77.2. All patients achieved full functional range of motion by the end of 4 months. No nerve injury was reported. Conclusion:Modified technique for percutaneous Kwire fixation using the fixator mini clamps and rods is an effective and economical method allowing biological preservation with good results.

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“…Improvements of minimally invasive techniques with real-time 3D fracture imaging and better indirect reduction tools may change this situation. Early functional treatment enabled most of our patients to have a good range of motion despite moderate displacement, an aspect of rehabilitation stressed in other studies [22,23] .…”

Section: Discussionmentioning

confidence: 67%

Hackethal Bundle Nailing with Intramedullary Elastic Nails in the Treatment of Two- and Three-Part Fractures of the Proximal Humerus: Initial Experience at Al Razi Hospital, Kuwait

Pospula¹,

Noor²

2009

Med Princ Pract

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Objective: To present the clinical and radiological results of a minimally invasive technique, the fixation of two- and three-part fractures of the proximal humerus according to the Neer Classification System, using the intramedullary bundle-wiring Hackethal technique. Subjects and Methods: The operations were performed with the Hackethal technique (use of elastic titanium nails, Synthes) on 17 patients (8 males and 9 females) with two- and three-part fractures of the proximal humerus. In cases of two-part fracture only, intramedullary titanium nails were used while for three-part fractures, percutaneous cannulated screws were used to fix the greater tuberosity, followed by intramedullary insertion of titanium elastic nails. The clinical results were assessed using the Constant score and radiological assessment including the union and alignment of the proximal humerus. Preoperative and postoperative CT scans were performed along with 3D reconstruction in all cases for diagnostic and prognostic significance. Results: All fractures united in an average period of 12 weeks (range 10–17 weeks). In all patients, a good to excellent range of motion of the shoulder, and good to excellent muscular power and alignment were noted. The Constant score amounted to 81 points (range 64–98 points). There was no secondary loss of fixation and migration of implants. Conclusion: In cases of two-part fracture of the proximal humerus, the minimally invasive Hackethal technique alone and in cases of three-part fracture, the same technique with percutaneous cannulated screws provided excellent clinical and radiological results with a minimal risk of complication. It is an important alternative to open reduction and internal fixation of these difficult fractures.

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Rehabilitation after two-part fractures of the neck of the humerus

Cited by 88 publications

References 30 publications

Functional outcome following external fixator (JESS) application for proximal humeral fractures

Functional outcome following external fixator (JESS) application for proximal humeral fractures

Evaluation of functional outcomes of a modified technique for percutaneous pinning of proximal humeus fracture

Hackethal Bundle Nailing with Intramedullary Elastic Nails in the Treatment of Two- and Three-Part Fractures of the Proximal Humerus: Initial Experience at Al Razi Hospital, Kuwait

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