Early or late mobilisation in uncomplicated neck of humerus fractures
Date First Published:
March 23, 2004
Last Updated:
January 25, 2008
Report by:
Mark Tighe and Jane Miles, Senior House Officers (North Hampshire Hospital, Basingstoke)
Search checked by:
Howard Simpson, North Hampshire Hospital, Basingstoke
Three-Part Question:
In [the elderly with minimally displaced, uncomplicated neck of humerus fracture] is [early mobilisation better than delayed mobilisation] at [maximising recovery of function].
Clinical Scenario:
A 75 year old woman attends the emergency department having fallen at home. She has pain around her left upper arm, and is reluctant to move it. Examination reveals a probable fracture of the humerus and an x-ray confirms this. There are no neurovascular complications or displacement. The Orthopaedic team give differing advice about how you should immobilise her arm and what advice you can give her about when she can start to move it. You wonder if there are any studies that address this.
Search Strategy:
Medline 1950 to November Week 2 2007
EMBASE 1980 to 2007 Week 52
The Cochrane Library Issue 4 2007
EMBASE 1980 to 2007 Week 52
The Cochrane Library Issue 4 2007
Search Details:
Medline: (exp Shoulder Fractures/ OR proximal adj humer$ adj fracture$.mp.) AND (exp "recovery of function"/ OR mobilis$.mp. OR mobiliz$.mp.) LIMIT to human and English language 55 records
EMBASE: exp Humerus Fracture/ OR (proximal adj humer$ adj fracture$).mp. AND exp MOBILIZATION/ OR mobilis$.mp. OR mobiliz$.mp.) LIMIT to humans and English 50 articles
Cochrane: MeSH descriptor Shoulder Fractures explode all trees
EMBASE: exp Humerus Fracture/ OR (proximal adj humer$ adj fracture$).mp. AND exp MOBILIZATION/ OR mobilis$.mp. OR mobiliz$.mp.) LIMIT to humans and English 50 articles
Cochrane: MeSH descriptor Shoulder Fractures explode all trees
Outcome:
105 articles found two of which were relevant and of sufficient quality for inclusion.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Rehabilitation of two-part fractures of the neck of the humerus (two-year follow-up). Hodgson SA, Mawson SJ, Saxton JM et al. 2007, UK | 86 patients with 2-part fractures of the proximal humerus Immediate physiotherapy (44) vs delayed physiotherapy after 3 weeks (42) |
PRCT | Shoulder disability (Croft score) at 1 year | 42.8% vs 72.5% | |
| Shoulder disability (Croft score) at 2 years | 43.2% vs 59.5% | ||||
| Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture: A randomized controlled trial. Lefevre-Colau MM, Babinet A, Fayad F et al. 2007, France | 64 patients with impacted proximal humeral fractures Early mobilisation (32) vs conventional treatment (32) |
PRCT | Constant score (0 – 100) at 3 months | 71 vs 61.1 (P = 0.02) | |
| Constant score (0 – 100) at 6 months | 81.5 vs 75.4 P = 0.07) |
Author Commentary:
The studies both point to early mobilisation having a positive early effect on functioning which is very beneficial in this age group. The difference decreases over time, (with the late mobilisation group showing greater late improvement in function. A Cochrane review has been performed on this topic, but this data postdates it.
Bottom Line:
There is evidence to support early mobilisation in uncomplicated fractured neck of humerus in the elderly.
References:
- Hodgson SA, Mawson SJ, Saxton JM et al.. Rehabilitation of two-part fractures of the neck of the humerus (two-year follow-up).
- Lefevre-Colau MM, Babinet A, Fayad F et al.. Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture: A randomized controlled trial.