The Journal of Bone and Joint Surgery (American). 2007;89:2582-2590.
doi:10.2106/JBJS.F.01419
© 2007 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the activities for this article:
 Shoulder/Elbow Test 22: Winter 2008 (publication date February 15, 2008; ex...
CME 4: October, November, December 2007 (publication date January 4, 2008; ...
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lefevre-Colau, M.M.
Right arrow Articles by Poiraudeau, S.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Lefevre-Colau, M.M.
Right arrow Articles by Poiraudeau, S.
Related Collections
Right arrow Adult Trauma
Right arrow Shoulder
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Immediate Mobilization Compared with Conventional Immobilization for the Impacted Nonoperatively Treated Proximal Humeral Fracture

A Randomized Controlled Trial

M.M. Lefevre-Colau, MD, PhD1, A. Babinet, MD2, F. Fayad, MD, MS2, J. Fermanian, MD, PhD3, P. Anract, MD2, A. Roren, PT2, J. Kansao, MD2, M. Revel, MD, PhD2 and S. Poiraudeau, MD, PhD2

1 Department of Rehabilitation Medicine, Corentin-Celton Hospital (Assistance Publique-Hôpitaux de Paris), University Paris V, 4 Parvis Corentin Celton, BP66, 92133 Issy-les-Moulineaux Cedex, France. E-mail address: marie-martine.lefevre-colau{at}ccl.aphp.fr
2 Departments of Orthopaedic Surgery (A.B. and P.A.), Rehabilitation Medicine (F.F., A.R., M.R., and S.P.), and Emergency (J.K.), Cochin Hospital (Assistance Publique-Hôpitaux de Paris), University Paris V, 75679 Paris Cedex 14, France
3 Department of Biostatistics, Necker Hospital (Assistance Publique-Hôpitaux de Paris), University Paris V, 75743 Paris Cedex 15, France

Investigation performed at Cochin Hospital (Assistance Publique-Hôpitaux de Paris), University Paris V, Paris, France

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Department of Clinical Research of the Assistance Publique-Hopitaux de Paris (APHP). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: There have been few randomized controlled trials evaluating nonoperative treatment of proximal humeral fractures. To investigate shortening the period of dependence, we assessed the feasibility and efficacy of early mobilization of the shoulder (within three days after the fracture) in comparison with those of conventional three-week immobilization followed by physiotherapy.

Methods: We randomly assigned seventy-four patients with an impacted proximal humeral fracture to receive early passive mobilization or conventional treatment. The primary outcome was the overall shoulder functional status (as measured with the Constant score) at three months. The secondary outcomes were the Constant score at six weeks and at six months, the change in pain (on a visual analog scale), and the active and passive range of motion.

Results: At three months and at six weeks, the early mobilization group had a significantly better Constant score than did the conventional-treatment group (between-group difference, 9.9 [95% confidence interval, 1.9 to 17.8] [p = 0.02] and 10.1 [95% confidence interval, 2.0 to 18.1] [p = 0.02], respectively) and better active mobility in forward elevation (between-group difference, 12.0 [95% confidence interval, 1.7 to 22.4] [p = 0.02] and 28.1 [95% confidence interval, 7.1 to 49.1] [p = 0.01], respectively). At three months, the early mobilization group had significantly reduced pain compared with the conventional-treatment group (between-group difference, 15.7 [95% confidence interval, 0.52 to 30.8] [p = 0.04]). No complications in displacement or nonhealing were noted.

Conclusions: Early mobilization for impacted nonoperatively treated proximal humeral fractures is safe and is more effective for quickly restoring the physical capability and performance of the injured arm than is conventional immobilization followed by physiotherapy.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Clin Med ResHome page
J. M. M. Guix, J. S. Pedros, and A. C. Serrano
Updated Classification System for Proximal Humeral Fractures
Clin. Med. Res., June 1, 2009; 7(1-2): 32 - 44.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. L. Ramsey, C. L. Getz, and B. O. Parsons
What's New in Shoulder and Elbow Surgery
J. Bone Joint Surg. Am., May 1, 2009; 91(5): 1283 - 1293.
[Full Text] [PDF]

Home page
 JBJSHome page
P. A. Cole, T. Miclau III, T. V. Ly, J. A. Switzer, M. Li, R. A. Morgan, and M. Bhandari
What's New in Orthopaedic Trauma
J. Bone Joint Surg. Am., December 1, 2008; 90(12): 2804 - 2822.
[Full Text] [PDF]

Home page
 JBJSHome page
T. Murase, K. Oka, H. Moritomo, A. Goto, H. Yoshikawa, and K. Sugamoto
Three-Dimensional Corrective Osteotomy of Malunited Fractures of the Upper Extremity with Use of a Computer Simulation System
J. Bone Joint Surg. Am., November 1, 2008; 90(11): 2375 - 2389.
[Abstract] [Full Text] [PDF]

Home page
 Emerg. Med. J.Home page
M. Tighe, J. Miles, and H. Simpson
BET3. EARLY OR LATE MOBILISATION IN UNCOMPLICATED NECK OF HUMERUS FRACTURES
Emerg. Med. J., April 1, 2008; 25(4): 223 - 224.
[Full Text] [PDF]