Original Article
Results measured by means of a motion capture system in proximal humerus fractures treated by osteosynthesis with locking plateResultados medidos con captura de movimiento en las fracturas de húmero proximal tratadas mediante osteosíntesis con placa bloqueada

https://doi.org/10.1016/j.recote.2019.05.004Get rights and content

Abstract

Objective

To evaluate the results after locking plate internal fixation of proximal humerus fractures by means of a motion capture system, and functional scales.

Material and method

Retrospective study of a cohort of 47 elderly patients undergoing surgery from January 2010 to December 2014. After a minimum follow-up of two years, two functional scales (Constant-Murley and Quick DASH), and a quality of life scale (EQ-5D) were used for clinical evaluation. For objective evaluation of the range of motion a kinematic marker-free analysis with cameras was performed.

Results

The average age was 74.85 years. Average functional scores were: Constant-Murley 70.06 points, Quick DASH 35.74 points and EQ-5D 6.79 points. The average range of motion was: flexion, 111.49°; extension: 24.13°; abduction: 109.40°; adduction: 15.13°; external rotation: 38.96°, and internal rotation: 49.28°. Correlation was found between the two functional scales, between them and the EQ-5D, and between range of motion and functional scales (except for external rotation) as well as between range of motion and EQ-5D (except for flexion and external rotation).

Conclusion

Locking plate osteosynthesis in proximal humerus fragility fractures achieved good functional and quality of life scores. Motion capture systems can be a useful tool for the functional assessment of shoulder pathology allowing an objective evaluation of range of motion.

Resumen

Objetivo

Evaluar los resultados de las fracturas de húmero proximal tratadas mediante osteosíntesis con placa empleando captura de movimiento y escalas funcionales.

Material y método

Estudio retrospectivo de 47 pacientes mayores de 65 años, tratados mediante osteosíntesis con placa bloqueada en el mismo centro, desde enero de 2010 a diciembre de 2014. Tras un seguimiento mínimo de 2 años, se realizó una evaluación de los resultados obtenidos mediante 2 escalas funcionales (Constant-Murley y Quick DASH) y una escala de calidad de vida (EQ-5D). Para analizar el balance articular de forma objetiva se empleó un sistema de análisis cinemático con cámaras y sin marcadores.

Resultados

La edad media fue 74,85 años. Los resultados funcionales expresados mediante la puntuación media fueron: Constant-Murley, 70,06 puntos; Quick DASH, 35,74 puntos; y EQ-5D, 6,79 puntos. Los arcos de movilidad medios fueron: flexión, 111,49°; extensión: 24,13°; abducción: 109,40°; aducción: 15,13°; rotación externa: 38,96° y rotación interna: 49,28°. Se encontró correlación estadística entre las 2 escalas funcionales y de ambas con la EQ-5D. También se advirtió correlación estadística entre los movimientos estudiados con las escalas funcionales (excepto rotación externa) y con la escala de calidad de vida (excepto flexión y rotación externa).

Conclusión

La osteosíntesis con placa bloqueada en las fracturas de húmero proximal del anciano obtiene unos buenos resultados funcionales y de calidad de vida. El uso de sistemas de captura de movimiento permite una medición más objetiva de estos resultados y puede ser una herramienta útil en la valoración funcional de esta patología.

Introduction

Proximal humerus fractures have a high incidence rate in the population, particularly after 65 years of age, making it the third most common fracture after hip and wrist fractures.1 The most widely used treatment is still conservative treatment2 and in up to 80% of the cases, the fractures are minimally displaced and good outcomes are achieved without surgery.3 Nevertheless, there are many patients who will require surgical treatment due to the high volume of this pathology. These fractures represent a challenge for the surgeon because of their complexity, the many existing treatment options, and the high risk of complications they entail.

There is no clear consensus in the bibliography with respect to what the best option is for use in those cases that do require surgery, and individualised treatment is advocated. One of the most widely used alternatives is the utilisation of locking plates with angular stability. These implants provide outstanding primary biomechanical stability,3, 4 even in osteoporotic bone, enabling the previous proximal humerus anatomy to be restored.5 While the functional results obtained with this type of fixation are satisfactory, a significant number of complications have been noted in relation to the osteosynthesis of these fractures.6, 7, 8

Several validated scales have been used to evaluate the functional outcomes following surgery for these fractures, but all of them exhibit a certain degree of subjectivity.9, 10

The use of kinematics has been suggested to distinguish between true recovery (restoration of premorbid movement) and the use of compensatory (alternative) movement patterns while carrying out a task.11

Three dimensional kinematic motion capture yields an objective measurement of the joint's range of movement12 and, consequently, its comparison and expression in numeric values. Kinematic analysis describes the movements of the body through space and time, including linear and angular displacements, speeds, and accelerations.

The main objective of this study is to present the results obtained following open reduction and internal fixation with angular stability locking plate of proximal humerus fractures by means of motion capture and functional rating scales in elderly patients.

Section snippets

Material and method

A retrospective study of 47 patients with a displaced proximal humerus who underwent surgery with of osteosynthesis by means of a plate at an Orthopaedic Surgery and Trauma Service during the period of time between January 2010 and December 2014.

Patients were included who were over the age of 65 years, with proximal humerus fracture, treated by means of osteosynthesis with a Philos plate (DePuy Synthes, Switzerland) at our centre, who completed follow up, and agreed to undergo the kinematic

Results

Of the 156 patients who underwent surgery during the time period indicated, 47 met the inclusion criteria and agreed to be interviewed for a clinical evaluation 2 years following surgery and were finally eligible for admission into the study.

The sample's demographic characteristics are displayed in Table 1.

The aetiology of the fracture was an accidental fall with low energy trauma in the 100% of the cases.

The mean follow up was 4.69 years, with a range of between 2.49 and 7.14 years.

The type of

Discussion

There are any number of studies that offer the clinical results attained in the treatment of proximal humerus fractures in the elderly, but no clear consensus exists as to what the best treatment option is.13, 14 In addition to those that collect the functional results obtained from conservative treatment, by means of osteosynthesis with locking plate and, more specifically, with the Philos plate,15, 16, 17, 18, 19 recent works have evaluated the barrage of new options, such as total reverse

Conclusions

Osteosynthesis with locking plate in proximal humerus fractures in the elderly achieves good functional results and quality of life. Motion capture is an emerging tool that makes it possible to obtain objective measurements when assessing outcomes in these patients and correlate appropriately with the functional scales typically used, as well as with quality-of-life scales. We believe that it is an alternative that enables better interindividual comparisons to be made, given its objectiveness,

Level of evidence

Level of evidence IV.

Conflict of interests

None declared.

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  • Cited by (0)

    Please cite this article as: Gómez-Blasco AM, Hernández-Fernández A, Roche-Albero A, Martín-Hernández C. Resultados medidos con captura de movimiento en las fracturas de húmero proximal tratadas mediante osteosíntesis con placa bloqueada. Rev Esp Cir Ortop Traumatol. 2019;63:268–274.

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