Revista Española de Cirugía Ortopédica y Traumatología (English Edition)
Original ArticleResults 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☆
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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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.