Grimme Sebastian, Bail Hermann Josef, Rüther Johannes, Millrose Michael, Biber Roland, Gesslein Markus, Willauschus Maximilian
Department of Orthopedics and Traumatology, Paracelsus Medical University, General Hospital Nuremberg, Breslauer Straße 201, 90471 Nuremberg, Germany.
Department of Orthopedics and Traumatology, University Hospital Basel, 4031 Basel, Switzerland.
J Pers Med. 2024 Aug 27;14(9):907. doi: 10.3390/jpm14090907.
Proximal humerus fractures are common fractures of the elderly population which can lead to long-term compromise of a patient's shoulder function. Closed reduction and internal fixation with intramedullary nailing is a well-established surgical technique yielding good outcomes, as perceived by patients, obtained via Patient-Reported Outcome Measures, and objectified by clinical shoulder testing. Apart from conventional range-of-motion testing and clinical shoulder tests, strength testing of the shoulder is a yet-neglected but meaningful and standardizable outcome parameter. In this study, isometric shoulder strength is evaluated in relation to fracture morphology/postoperative reduction quality as well as with patient-reported outcomes.
25 patients (mean age 73.2 ± 10.5 years) underwent isometrics strength-testing of the shoulder joint in the scapular plane (abduction) as well as in the sagittal plane (flexion) as well as hand-grip strength-testing at 4.5 ± 1.88 years follow-up. Pre- and postoperative radiographs were analysed. Patients completed ASES and CMS questionnaires.
Patients exhibited a decrease in abduction and flexion force (-24.47% and -25.30%, respectively, < 0.001) using the contralateral, uninjured arm as reference. Abduction force tended to be decreased in three- and four-part fractures. Patient satisfaction correlated negatively with the relatively reduced force of the affected arm. Varus-angulated humeral heads produced significantly lower abduction force output than valgus- or physiologic angulation ( = 0.014), whereas flexion force was unaffected ( = 0.468). The anatomical reduction had no influence on shoulder strength.
Proximal humerus fractures may cause a significant reduction in shoulder function, both reported by patients and objectified by shoulder strength testing. Varus head angulation demonstrated the greatest loss of shoulder strength and should be avoided to ensure proper functioning. Further, strength testing seems a valuable outcome parameter for a thorough shoulder examination with easy obtainability.
肱骨近端骨折是老年人群常见的骨折类型，可导致患者肩部功能长期受损。髓内钉闭合复位内固定是一种成熟的手术技术，通过患者报告的结局指标评估，患者认为效果良好，并通过临床肩部检查得到客观验证。除了传统的活动范围测试和临床肩部检查外，肩部力量测试是一个尚未受到重视但有意义且可标准化的结局参数。在本研究中，评估了等长肩部力量与骨折形态/术后复位质量以及患者报告结局之间的关系。
25例患者（平均年龄73.2±10.5岁）在随访4.5±1.88年时接受了肩关节在肩胛平面（外展）和矢状面（屈曲）的等长力量测试以及握力测试。分析术前和术后的X线片。患者完成了ASES和CMS问卷。
以对侧未受伤手臂为参照，患者的外展和屈曲力量均下降（分别下降24.47%和25.30%，<0.001）。三部分和四部分骨折的外展力量往往会下降。患者满意度与患侧手臂相对力量的降低呈负相关。内翻成角的肱骨头产生的外展力量输出明显低于外翻或生理成角（P=0.014），而屈曲力量不受影响（P=0.468）。解剖复位对肩部力量没有影响。
肱骨近端骨折可能导致肩部功能显著下降，这在患者报告中以及通过肩部力量测试得到客观证实。肱骨头内翻成角显示肩部力量损失最大，应避免以确保正常功能。此外，力量测试似乎是全面肩部检查的一个有价值的结局参数，且易于获得。
