Immediate intensive mobilization compared with immediate conventional mobilization for the impacted osteoporotic conservatively treated proximal humeral fracture: a randomized controlled trial.
Musculoskelet Surg
; 101(Suppl 2): 137-143, 2017 Dec.
Article
em En
| MEDLINE
| ID: mdl-28770512
ABSTRACT
PURPOSE:
To select in a 2-year survey of proximal humerus fractures accessing the emergency department, a population of osteoporotic stable impacted fractures and to randomize them into two groups, one with an immediate intensive mobilization program and the other with an immediate conventional mobilization program.METHODS:
In emergency department, patients with clinical signs of shoulder girdle fracture were submitted to standard X-ray examination and CT scan. Patients with stable (absence of metaphyseal comminution or fifth fragment) osteoporotic (cortical bone thickness lower than 6 mm) impacted (Is any part of metaphysis or head impacted into the shaft? YES/NO) proximal humerus fractures were selected for randomization in one of the two groups. Group 1 early intensive mobilization; Group 2 early conventional mobilization. Functional and radiographic assessment was recorded at 3, 6 and 12 months of follow-up.RESULTS:
In the considered period, 120 patients were affected by a stable impacted osteoporotic proximal humerus fracture. At the final follow-up, 36 patients in group 1 and 39 patients in group 2 were available for statistical analysis. Functional and radiographic scores were comparable, with a trend of significance in favor of group 2. No fracture in any of the group showed significant loss of reduction respect to 6 months of follow-up. 4 (10%) and 1 (2.5%) patients in groups 1 and 2 were not compliant with the rehabilitation program (p = 0.037).CONCLUSIONS:
This randomized controlled trial showed that impacted osteoporotic proximal humerus fractures can be managed non-operatively with an early conventional rehabilitation program composed by 10 sessions of passive motion twice a week, followed by recovery of active range of motion for further 10 sessions thrice a week, while no advantage is given by a more aggressive rehabilitation regimen. Self-assisted exercises should be explained to patients to maximize the effects of the assisted program. LEVEL OF EVIDENCE Level 1, randomized controlled double-blinded trial.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Osteoporose
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Fraturas do Ombro
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Terapia por Exercício
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Fraturas Espontâneas
Tipo de estudo:
Clinical_trials
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Etiology_studies
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Musculoskelet Surg
Assunto da revista:
ORTOPEDIA
Ano de publicação:
2017
Tipo de documento:
Article
País de afiliação:
Itália