Humeral Diaphysis Fracture, Humeral Upper Extremity Fracture
Conditions
Keywords
Speed of functional recovery, Humeral fractures, Anterograde nailing, Rotator cuff split, Prospective randomized study
Brief summary
The aim of the study is to show if there is any speed difference of functional recovery for people with humeral fracture, treated by an anterograde nail, which will be inserted through the rotator cuff (the common way) or through the rotator interval split. The patients included in this study will be randomized to one of the two groups. The recovery will be evaluated by the Constant score over time, for a year. The main hypothesis is the rotator interval split approach allows a faster functional recovery after humeral nailing, by avoiding opening the rotator cuff.
Detailed description
Humeral fractures are the third most common fractures over 65 years and represent 8% of all fractures. The anterograde nailing is known to be an efficient way to treat humeral upper extremity fractures and humeral diaphysis fractures. The main complications of this nailing are pain, shoulder stiffness, rotator cuff tendinitis and impingement. Studies have proven these problems can be due to the entry portal of the nail. Indeed, it is inserted through the supra-spinatus tendon, which means an opening of the rotator cuff even if it is closed at the end of the procedure. But the rotator interval split in the shoulder can allow to insert the nail through it without opening the cuff or damaging the cartilage. It is located between the anterior side of the supra-spinatus tendon and the posterior side of the long part of the biceps. The aim of the study is to compare the speed of functional recovery according to the entry portal, which are through the rotator cuff or through the rotator interval split, in humeral fractures treated by anterograde nailing. The cutaneo-muscular approach will be the same in both groups, namely a trans-deltoid approach. People will be included in the study after an enlightened and signed consent, afterward they will be randomized to one of the two groups. To evaluate the primary outcome, the Constant Score will be used to measure the kinetic of the recovery. The secondary outcomes are residual pain (measured by the VAS an evaluation of complications and a radiological review (two different reviewers) to follow the healing and search any side effects, the sick leave and rehabilitation durations. The patients need to be available for a one-year follow-up. Each assessment will be checked at 21 and 45 days, and at 3, 6 and 12 months after the surgery.
Interventions
PROCEDUREHumeral neailling in humeral fractures
Humeral neailling in humeral fractures
Sponsors
University Hospital, Clermont-Ferrand
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Approach through the rotator cuff or through the rotator cuff split
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Be available for a one year follow-up * Patients over 18 and under 70 years old * Humeral diaphysis fracture or humeral upper extremity articular fracture (Neer 2,3 or 4), needing to be treated by anterograde nailing. * No growth plates * Patients covered by the French social security service * Patients able to give their enlightened consent and to answer the questions asked for the trial
Exclusion criteria
* Pregmant, breastfeeding or potentially pregmant woman * Existing bone disease * Polytrauma * Other fractures on the same upper limb * Pathologic fracture * Medical history of surgery on the same shoulder * Contra-indication to the surgery or the anesthesia * Infection on the operating site * Axillary nerve palsy * Deltoid dysfunction * Major disability * Refusal of participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Speed of functional recovery | Day 21 | Measured by the objective Constant score (absolute and weighted values), which includes an evaluation of the pain, level of daily activities, use of the hand, range of motion and strength. The collected data will allow us to draw a diagram to compare the speed of recovery. Its values are between 0 (bad) and 100 (good) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Quick Dash | Day 21 | subjective test showing any difficulties in the daily living activities, relationships, and evaluating the pain and tingling; all of these items are based on the week before the assessment. It ranges from 0 to 100 more the value is better brought up is the score. |
| Simple shoulder test (SST) | day 21 | a subjective score to evaluate what kind of activity is actually possible for the patient |
| Intensity of Pain | Day 21 | Visual analog scale (VAS) : the pain is quantified by a number from 0 (no pain) to 10 (the worst pain ever known) |
| Duration of the sick leave | day 21 | The patient is asked when he has returned to his professional activity |
| Complications assessment | day 0 | Searching any early or late complications, such as neurological or vascular problems, haematoma, infection, dislocation, with a clinical exam or other possible paraclinical exams |
| Surgery datas | during the surgery and immediately after (Day 0) | any or no transfusion of blood cells |
| haemoglobin levels | during the surgery and immediately after (Day 0) | haemoglobin levels in g/dl |
| Radiological evolution | Day 45 | consolidation or not |
| Duration of the rehabilitation | day 21 | The patient is asked about the length of the physiotherapy. |
Countries
France
Outcome results
None listed