de Souza Serenza Felipe, Rizzato Marília Manuella Simões Augusto, Vieira Fernando, McQuade Kevin James, de Oliveira Anamaria Siriani
Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Brazil.
Health Sciences Department, Ribeirão Preto Medical School, University of São Paulo, Brazil.
Clin Biomech (Bristol). 2025 Feb;122:106432. doi: 10.1016/j.clinbiomech.2025.106432. Epub 2025 Jan 11.
Upper limb fractures significantly alter movement, impacting function and recovery. Three-dimensional motion analysis allows precise assessment of these changes.
Sixty patients were divided into four groups: shoulder, elbow, wrist fractures, and controls. Functional assessment was performed using the DASH questionnaire, followed by three-dimensional kinematic analysis with eight Oqus 300 cameras and 14 reflective markers on the thorax, scapula, humerus, forearm, and hand. The Acromion Marker Cluster method was used for accurate scapular tracking. Tasks analyzed included hand on shoulder, hand on back, and hand on neck. All measured variables are expressed in degrees. The analysis focused on the differences in maximum joint angles for each degree of freedom across the tasks. These differences were assessed using MANOVA, followed by ANOVAs and Tukey's post hoc test when applicable.
Significant kinematic differences were observed between the fracture groups and the control group across all tasks. Shoulder fracture patients exhibited the greatest reductions in humeral flexion and abduction. Elbow fracture patients showed the most restricted elbow flexion. Wrist fracture patients presented significantly reduced radial/ulnar deviation. These movement impairments were observed across all tasks, with the most pronounced limitations seen in the hand-to-shoulder task. Effect sizes (η) indicated clinically meaningful impacts, particularly for shoulder and wrist movements.
This study reveals distinct kinematic alterations following upper limb osteosynthesis, emphasizing the need for individualized rehabilitation strategies addressing these specific movement impairments to optimize recovery.
上肢骨折会显著改变运动，影响功能和恢复。三维运动分析能够精确评估这些变化。
60名患者被分为四组：肩部骨折组、肘部骨折组、腕部骨折组和对照组。使用DASH问卷进行功能评估，随后使用8台Oqus 300摄像机和14个反光标记对胸部、肩胛骨、肱骨、前臂和手部进行三维运动学分析。采用肩峰标记簇方法进行精确的肩胛骨跟踪。分析的任务包括手搭在肩部、手搭在背部和手搭在颈部。所有测量变量均以度为单位表示。分析重点关注各任务中每个自由度的最大关节角度差异。这些差异采用多变量方差分析（MANOVA）进行评估，适用时随后进行方差分析（ANOVA）和Tukey事后检验。
在所有任务中，骨折组与对照组之间均观察到显著的运动学差异。肩部骨折患者的肱骨前屈和外展减少最为明显。肘部骨折患者的肘关节屈曲受限最为严重。腕部骨折患者的桡/尺侧偏斜明显减少。所有任务中均观察到这些运动障碍，在手搭肩部任务中受限最为明显。效应量（η）表明具有临床意义的影响，尤其是对肩部和腕部运动。
本研究揭示了上肢骨合成术后明显的运动学改变，强调需要针对这些特定的运动障碍制定个性化康复策略，以优化恢复。
