The N-brace trial: Does arm position during immobilisation of proximal humerus fractures influence outcome - A preliminary study.
| Autor: | Gokaraju K; Trauma and Orthopaedic, Northern General Hospital, Sheffield, UK., Ahrens P; Trauma and Orthopaedic, Royal Free London NHS Foundation Trust, London, UK., Boileau P; Orthopaedic Surgery and Traumatology, Centre Hospitalier Universitaire de Nice Hôpital Pasteur, Nice, Provence Alpes-Côte d'Azu, France., Baring T; Orthopaedics, Homerton University Hospital, London, UK. |
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| Jazyk: | angličtina |
| Zdroj: | Shoulder & elbow [Shoulder Elbow] 2023 Oct; Vol. 15 (5), pp. 513-521. Date of Electronic Publication: 2022 Dec 07. |
| DOI: | 10.1177/17585732221142505 |
| Abstrakt: | Background: Traditional initial management of proximal humerus fractures (PHF) involves arm immobilisation in a simple sling (SS) in an internally rotated position. We believe this risks fracture displacement and imbalance of soft tissues, encouraging malunion and stiffness. A neutral-rotation brace (NRB) maintains an arm position which may prevent this, leading to quicker and superior recovery. Methods: We randomised patients with two- to four-part PHF into 4 weeks of immobilisation with either a SS or NRB, independent of surgery. Range of motion (ROM), subjective shoulder value (SSV), DASH, Constant-Murley (CMS) and Oxford Shoulder (OSS) scores were assessed at 6-weeks, 3-months and 1-year post-injury. Results: The SS group included 11 patients vs 9 in the NRB group. At final follow-up, the SS and NRB groups had mean DASH scores of 42 vs 35, OSS 42 vs 46, CMS 71 vs 86, SSV 84% vs 92%, respectively. ROM was superior with the NRB (elevation 159°, ER 47° and IR score 8 vs 140°, 37° and 7 with SS). Conclusions: Despite being a small series, our results demonstrate a trend towards NRB providing better outcomes. This feasibility study supports the need for a larger multi-centre randomised controlled trial comparing these immobilisation methods for PHF. Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. (© The Author(s) 2022.) |
| Databáze: | MEDLINE |
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