Orthopaedic Division, Tel Aviv Souraski Medical Center, Tel Aviv, Israel.
J Shoulder Elbow Surg. 2013 Oct;22(10):e8-e11. doi: 10.1016/j.jse.2013.01.033. Epub 2013 Apr 29.
Minimally displaced (<3 mm) and non-displaced fractures of the proximal humerus are a common source of disability; nevertheless, there is no agreement on the recommended rehabilitation program in these patients. The purpose of this study was to evaluate the outcome of this group of patients and describe the rehabilitation protocol we have used for the treatment of this injury.
We retrospectively analyzed the records of patients diagnosed with minimally displaced (<3 mm) fractures of the greater tuberosity who were admitted to our institute between June 2007 and May 2008. Patients were treated with a three-phase protocol. In the first phase, patients were immobilized in a sling for 3 weeks. In the second phase, pendular and active assisted exercises were begun 3 to 6 weeks after the injury. In the third phase, active exercises were commenced starting 6 weeks after injury.
Sixty-nine patients matched our inclusion and exclusion criteria. At an average follow-up of 31 months (range, 26-41 months), the average Constant score improved from 40 points (range, 33-58 points) to 95 points (range, 75-100 points). Average satisfaction score improved from 4.2 of 10 (range, 2-6) to 9.5 of 10 (range, 7-10). The reported average duration of pain and decreased range of motion from the time of injury was 8.1 months (range, 1-24 months).
When the diagnosis of a minimally displaced fracture of the proximal humerus is made, the patient can be reassured that a favorable outcome is anticipated with a staged rehabilitation protocol. Nevertheless, clinicians and patients should be aware that full recovery from the injury may take an average of 8 months.
肱骨近端微小移位（<3mm）和无移位骨折是导致残疾的常见原因；然而，对于此类患者，推荐的康复方案尚无定论。本研究旨在评估该组患者的预后，并描述我们用于治疗这种损伤的康复方案。
我们回顾性分析了 2007 年 6 月至 2008 年 5 月期间在我院就诊的肱骨大结节微小移位(<3mm)骨折患者的病历。患者采用三阶段方案治疗。在第一阶段，患者用吊带固定 3 周。在第二阶段，受伤后 3-6 周开始进行摆动和主动辅助运动。在第三阶段，受伤后 6 周开始进行主动运动。
符合纳入和排除标准的 69 例患者。平均随访 31 个月（范围 26-41 个月）后，Constant 评分从 40 分（范围 33-58 分）提高至 95 分（范围 75-100 分）。平均满意度评分从 4.2（范围 2-6）提高至 9.5（范围 7-10）。报告的疼痛和活动范围受限的平均持续时间为 8.1 个月（范围 1-24 个月）。
当诊断为肱骨近端微小移位骨折时，可向患者保证，采用分期康复方案可获得良好的预后。然而，临床医生和患者应意识到，从受伤到完全康复可能需要平均 8 个月的时间。
