Hameleers Amber, Boonen Bert, Most Jasper, Dremmen Martijn, Schotanus Martijn G M, Van Vugt Raoul
Department of Orthopedic Surgery, Zuyderland Medical Center, Sittard-Geleen, NLD.
Department of Surgery, Maastricht University Medical Center+, Maastricht, NLD.
Cureus. 2024 Apr 5;16(4):e57670. doi: 10.7759/cureus.57670. eCollection 2024 Apr.
Purpose Proximal humeral fractures (PHF) are common, particularly among the elderly due to low-energy trauma. Adequate rehabilitation is essential for functional recovery, whether through conservative or surgical treatment. Permissive weight bearing (PWB) is a relatively new rehabilitation concept, characterized by earlier mobilization of the affected limb/joint after trauma. Multiple studies demonstrated the value of PWB for the lower extremities, but this has not been translated to the upper extremity (i.e. PHF). Therefore, our aim was to investigate the current state and variability of rehabilitation of PHF and the role of implementing PWB principles in aftercare. Materials and methods An online survey, comprising 23 questions about the treatment of PHF, was distributed amongst an estimated 800 Dutch orthopaedic and trauma surgeons via the Dutch Orthopaedic and Dutch Trauma Society newsletter from May 2021 until July 2021. Results Among 88 respondents (n=69 orthopaedic, n=17 trauma surgeons, and n=2 other), most recommended early post-trauma mobilization (<6 weeks). Additionally, 53.4% (n=49) advised starting load bearing after six weeks for conservatively treated patients and 59.8% (n=52) for operative treatment. A wide variation of exercises used after immobilization was found in both groups. The usage of a sling after operative treatment was advised by 86% (n=74) of all 86 respondents. Conclusions The present study found limited consensus about PHF aftercare and the implementation of weight-bearing principles. The majority recommended early mobilization and advised the usage of a sling. A protocol capable of accommodating the diversity in aftercare (e.g. fracture type) is essential for maintaining structured rehabilitation, with PWB emerging as a promising example. More prospective studies are needed to form an evidence-based protocol focusing on the aftercare of PHF.
目的 肱骨近端骨折（PHF）很常见，尤其是在老年人中，多因低能量创伤所致。无论采用保守治疗还是手术治疗，充分的康复对于功能恢复至关重要。允许性负重（PWB）是一个相对较新的康复概念，其特点是创伤后更早地活动患肢/关节。多项研究证明了PWB对下肢的价值，但这尚未应用于上肢（即PHF）。因此，我们的目的是研究PHF康复的现状和变异性，以及在后续护理中实施PWB原则的作用。材料与方法 一项包含23个关于PHF治疗问题的在线调查，于2021年5月至2021年7月通过荷兰骨科和荷兰创伤学会通讯分发给约800名荷兰骨科和创伤外科医生。结果 在88名受访者中（n = 69名骨科医生，n = 17名创伤外科医生，n = 2名其他人员），大多数人建议创伤后早期活动（<6周）。此外，53.4%（n = 49）建议保守治疗的患者在六周后开始负重，手术治疗的患者为59.8%（n = 52）。两组在固定后使用的锻炼方法差异很大。所有86名受访者中有86%（n = 74）建议手术后使用吊带。结论 本研究发现，关于PHF的后续护理和负重原则的实施，共识有限。大多数人建议早期活动并建议使用吊带。一个能够适应后续护理多样性（如骨折类型）的方案对于维持结构化康复至关重要，PWB是一个有前景的例子。需要更多前瞻性研究来形成一个基于证据的方案，重点关注PHF的后续护理。
