Affiliations: Department of Orthopaedics and Traumatology, Piacenza Hospital, Italy
Correspondence:
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Corresponding author: Marco Caforio, Department of Orthopaedics and Traumatology, ``Guglielmo da Saliceto'' Hospital, Via Taverna 49, 20121 Piacenza, Italy. Tel.: +39 349 4507950; Fax: +39 0523 303120; E-mail:m.caforio@ausl.pc.it
Abstract: BACKGROUND: The aim of the surgical treatment in proximal humeral
fractures is to maintain bone alignment facilitating an early shoulder
mobilization. This can be obtained with the use of an endomedullary nail
with specific characteristics: a proximal angular multiplanar stability and
the possibility to place proximal screws in the calcar region. The objective
of this randomized controlled trial is to investigate the effects of an
early rehabilitation program in 3-part proximal humeral fractures treated
with endomedullary nailing. MATERIALS AND METHODS: 126 patients treated with the Diphos
Proximal Humeral Nail (PHN), followed with an Intensive Rehabilitation
Program (IRP) started in the second postoperative day, were compared to 62
patients with a Standard Rehabilitation Program (SRP) where shoulder
mobilization started after 3 weeks. The age of patients was under 65 years.
Main Outcome measures were improvement of shoulder function based on
Constant Score and quality of life on DASH questionnaire at 1, 3, 6 and 12
months after surgery. Safety outcome was no loss of radiological reduction
at any follow-up control. RESULTS: A difference considered statistically significant (95%
confidence interval) was demonstrated by Constant scores at 3 and 6 months
and by DASH questionnaire scores at 1 month after surgery between IRP and
SRP groups, however without loss of radiological reduction and maintaining
the full fracture healing at the same mean period of 1,8 ± 0,7 months. DISCUSSION: This experience allows to highlight essential features
of this new kind of endomedullary humeral nail, by its mechanical
properties, in proximal humeral fractures in order to permit an early
rehabilitation without creating displaced or consolidation delay. LEVEL OF EVIDENCE: III, randomized clinical-case-control study.
