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Gan JH, Bearne L, Walters S, Room J, Booth G, Trompeter A, Nikoletou D. The feasibility, acceptability, safety, and effects of early weight bearing in humeral fractures - a scoping review. Disabil Rehabil 2024:1-12. [PMID: 38753460 DOI: 10.1080/09638288.2024.2351594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/01/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Non-weight bearing is often recommended after humeral fractures. This review aims to summarise the extent and nature of the evidence for the feasibility, acceptability, safety, and effects of early weight bearing (EWB) in people with humeral fractures, treated operatively or non-operatively. . METHODS Data sources identified published (PUBMED, EMBASE, CINAHL) and unpublished (ClinicalTrials.gov, CENTRAL, NIHR Open Research, OpenGrey) literature. Independent data extraction was conducted by two reviewers. RESULTS 13 901 records were retrieved. Ten studies, involving 515 post-operative patients and 351 healthcare professionals, were included. EWB was found to be feasible in nine studies. There was limited evidence regarding adherence to EWB. Trauma and orthopaedic surgeons reported that EWB was acceptable. This depended on surgery type and whether it was a post-operative polytrauma case. No acceptability data was reported from patients' perspectives. Only one study reported two patients who developed unsatisfactory outcomes from excessive post-operative EWB. Positive effects of EWB were reported on disability level, pain, shoulder and elbow motion, and union. CONCLUSION There is some evidence for the feasibility, safety, and effectiveness of post-operative EWB after humeral fractures. There was limited data on the acceptability of EWB. Heterogeneous study designs, and variations in EWB protocols limit conclusions.
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Affiliation(s)
- Jia Hui Gan
- Haslemere Community Hospital, Royal Surrey NHS Foundation Trust, Surrey, UK
- Population Health Research Institute, St George's University of London, London, UK
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
| | - Lindsay Bearne
- Population Health Research Institute, St George's University of London, London, UK
| | - Samuel Walters
- Department of Trauma and Orthopaedic Surgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jon Room
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
- Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Greg Booth
- Population Health Research Institute, St George's University of London, London, UK
- Therapies Department, Royal National Orthopaedic Hospital Trust, London, UK
| | - Alex Trompeter
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
- Department of Trauma and Orthopaedic Surgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Dimitra Nikoletou
- Institute of Medical and Biomedical Education, St George's University of London, London, UK
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Helal A, Heimdal T, Lo EY, Montemaggi P, Lund J, Garofalo R, Ouseph A, Krishnan SG. Arthroplasty as Primary Treatment for Metadiaphyseal Proximal Humerus Fractures: A Viable Alternative to Osteosynthesis for the Elderly. J Shoulder Elb Arthroplast 2023; 7:24715492231192055. [PMID: 37547299 PMCID: PMC10399257 DOI: 10.1177/24715492231192055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/18/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction in the elderly patient population, where fracture comminution, osteoporotic fractures, and associated arthritis or rotator cuff pathologies dominate, metadiaphyseal proximal humeral fracture is a challenging subset of fractures to treat. This study reports on cementless long-stem reverse total shoulder arthroplasty (RTSA) as primary treatment of metadiaphyseal proximal humeral fractures in elderly patients. Materials & Methods Between January 2018 and October 2021, 22 consecutive patients sustained proximal humerus fractures with metadiaphyseal extension and underwent surgery with cementless long-stem RTSA. Patients older than 60 years with minimum 1 year of clinical and radiographic follow-up were included. Patient demographics, range of motion, and patient reported outcomes [Visual Analog Scale (VAS) pain scale, Simple Shoulder Test (SST), Subjective Shoulder Value (SSV), and American Shoulder Elbow Surgeon (ASES) scores] were retrospectively collected. Postoperative X-rays were evaluated for fracture and tuberosity union. Results There were 14 eligible patients with a median age of 71 years (range 61-91 years) and a median 13 months follow-up. At final follow-up, the median active elevation was 120° (range 80°-150°), external rotation was 40° (range 0°-50°), and internal rotation was 40° (range 0°-80°). Median VAS was 2 (range 0-8), SST was 71% (range 33%-92%), SSV was 78% (range 20-90%), and ASES was 73 (range 17-90). All patients exhibited radiographic union. There were five minor complications in three patients: postoperative neuropathy, tuberosity nonunion, scapula notching, and proximal humeral stress shielding. Conclusion Cementless long-stem RTSA is a viable alternative to primary fracture fixation in the elderly patient population with metadiaphyseal proximal humerus fractures.
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Affiliation(s)
- Asadullah Helal
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, Texas
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
| | - Tyler Heimdal
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, Texas
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
| | - Eddie Y Lo
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, Texas
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
| | - Paolo Montemaggi
- AOUP- Cisanello Hospital, Department of Orthopaedics and Trauma Surgery, University of Pisa, Pisa
| | - Julia Lund
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, Texas
| | | | - Alvin Ouseph
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, Texas
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
| | - Sumant G Krishnan
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, Texas
- The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas
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Hou N, Zhang H, Bai M, Chen H, Song W, Wang L. The Old Supracondylar Fracture of Femur Treated by Gradual Deformity Correction Using the Ilizarov Technique Followed by the Second-Stage Internal Fixation in an Elderly Patient With Osteoporosis. Geriatr Orthop Surg Rehabil 2020; 11:2151459320931673. [PMID: 32577319 PMCID: PMC7289063 DOI: 10.1177/2151459320931673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The supracondylar nonunion of femur in elderly individuals is rare and
challenging to manage. Nothing in English literatures or guidelines is
available regarding this particular fracture characterized by osteoporosis,
soft-tissue contracture, shortening, and joint stiffness. We report a case
of an elderly patient with a supracondylar nonunion of the femur, which was
successfully treated using staged Ilizarov techniques and dual plating. Case Presentation: An 84-year-old female patient was admitted to our orthopedic department for
her pain and soft-tissue swelling around the right knee with claudication
and shortening deformity of the affected extremity. She denied any specific
history of trauma and had sought traditional Chinese medical attention for 6
months before she presented to our hospital. Diagnosis of the right femoral
supracondylar nonunion was made based on the X-ray and computed tomography.
Ilizarov external fixator was carried out for successive and slow
distraction and gradual correction of the shortening deformity, in
consideration of the nonunion was still present. Subsequently, internal
fixation with dual plating of the distal femur was performed. Excellent
function and patient satisfaction were observed at 6 months of
follow-up. Conclusion: The protocol of Ilizarov technique with subsequent internal fixation of dual
plating seems to be an efficient solution to the supracondylar nonunion of
femur in elderly patients with osteoporosis. The advantage of the protocol
is that it allows knee joint motion, avoids neurovascular complications, and
gentle correction of soft-tissue contractures.
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Affiliation(s)
- Nianzong Hou
- Department of Orthopedic Surgery, Zibo Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Zibo, Shandong Province, China
| | - Haiyang Zhang
- Department of Orthopedic Surgery, Zibo Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Zibo, Shandong Province, China
| | - Mingjian Bai
- Department of Clinical Laboratory, Aerospace Central Hospital, Beijing, China
| | - Hao Chen
- Department of Orthopedic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Weidong Song
- Department of Orthopedic Surgery, Sun Yat-sen Memorial Hospital Affiliated to Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Liming Wang
- Department of Orthopedic Surgery, Zibo Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Zibo, Shandong Province, China
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Seyfettinoğlu F, Oğur HU, Tuhanioğlu Ü, Çiçek H, Kapukaya A. Management of AO type 12C humerus proximal metadiaphyseal fractures with minimally invasive plate osteosynthesis in geriatric patients. Clin Interv Aging 2018; 13:1003-1010. [PMID: 29861628 PMCID: PMC5968812 DOI: 10.2147/cia.s162356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the treatment efficacy and complications of the lateral minimally invasive plate osteosynthesis (MIPO) method in geriatric patients with a humerus diaphyseal fracture with proximal extension. Patients and methods The study included a total of 21 patients (18 females, 3 males; mean age 74±6.3 years, range 65–89 years) who underwent surgery with the lateral MIPO technique for a humerus diaphyseal fracture with proximal extension during the period January 2011 to December 2016. None of the patients had additional injuries and all completed regular follow-up. According to the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation classification system, the fractures were evaluated as 12C1 in 17 cases and 12C3 in 4 cases. All patients were evaluated radiologically and functionally at 6 months and 1 year. In the follow-up evaluations, the Constant–Murley score and the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score were used. Results No non-union, avascular necrosis or infection was seen in any patient. The mean time to union was 15.7 weeks. Impingement syndrome was seen in 2 patients and radial nerve palsy in 2 patients. The mean Constant–Murley score was 70.6±10.2 at 6 months and 84±7.6 at the end of 1 year. The mean Q-DASH score was 38.6±15.1 at 6 months and 21.9±13.1 at the end of 1 year. The increase in the Constant–Murley scores from 6 months to 1 year was statistically significant (p<0.0001). The decrease in the Q-DASH scores between 6 months and 1 year was determined to be statistically significant. In the 2 patients with radial nerve palsy, the functions were seen to completely recover during follow-up. No axillary nerve palsy was seen in any patient. Conclusion Metadiaphyseal humerus fractures with proximal extension in the elderly can be successfully treated with the lateral MIPO technique. When applied correctly, it is a method with high rates of union and low rates of complications.
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Affiliation(s)
- Firat Seyfettinoğlu
- Orthopaedics and Traumatology Department, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Hasan Ulaş Oğur
- Orthopaedics and Traumatology Department, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ümit Tuhanioğlu
- Orthopaedics and Traumatology Department, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Hakan Çiçek
- Orthopaedics and Traumatology Department, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ahmet Kapukaya
- Orthopaedics and Traumatology Department, Adana Numune Training and Research Hospital, Adana, Turkey
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