PDF(Pubmed)
Abstract：
UNASSIGNED: Proximal humerus fractures (PHFs) can lead to functional decline in geriatric and polytraumatized patients. Treatment of PHFs is an area of much debate and much variability between practitioners.
UNASSIGNED: We surveyed orthopedic trauma (OT) and shoulder and elbow (SE) surgeons to evaluate differences in postoperative protocols when treating acute PHFs with open reduction internal fixation (ORIF), intramedullary nailing (IMN), or hemi or reverse shoulder arthroplasty (rTSA).
UNASSIGNED: We distributed a web-based survey to three OT and SE associations between August 2018-April 2019. Questions included practice characteristics, standard postoperative protocols for weight-bearing, lifting, and range of motion (ROM) by treatment modality, and factors affecting modality and postoperative protocol decisions. We compared the subspecialties.
UNASSIGNED: 239 surgeons [100 (42.2 %) OT, 118 (49.8 %) SE] completed the survey. OT were more likely to allow immediate ROM, lifting, and weight bearing following intramedullary nailing (IMN), open reduction internal fixation with a locking plate (ORIF), or arthroplasty (all p < 0.025), and to allow earlier unrestricted use of the extremity following IMN and arthroplasty (p = 0.001, p = 0.021 respectively). OT were more likely to consider operating on a PHF if there was contralateral upper extremity injury or need of the injured arm for work or activities of daily living (all p < 0.026). The subspecialties did not differ significantly on factors affecting their postoperative protocols. OT preferred IMN and SE surgeons preferred rTSA for allowing immediate unrestricted postoperative weight bearing, ROM, or lifting (all p < 0.001).
UNASSIGNED: There are significant differences in postoperative protocols between trauma and SE surgeons when treating PHFs. Postoperative protocols should be further studied to balance surgical outcomes and the risks of functional decline when treating patients with PHFs.
UNASSIGNED: We surveyed orthopedic trauma (OT) and shoulder and elbow (SE) surgeons to evaluate differences in postoperative protocols when treating acute PHFs with open reduction internal fixation (ORIF), intramedullary nailing (IMN), or hemi or reverse shoulder arthroplasty (rTSA).
UNASSIGNED: We distributed a web-based survey to three OT and SE associations between August 2018-April 2019. Questions included practice characteristics, standard postoperative protocols for weight-bearing, lifting, and range of motion (ROM) by treatment modality, and factors affecting modality and postoperative protocol decisions. We compared the subspecialties.
UNASSIGNED: 239 surgeons [100 (42.2 %) OT, 118 (49.8 %) SE] completed the survey. OT were more likely to allow immediate ROM, lifting, and weight bearing following intramedullary nailing (IMN), open reduction internal fixation with a locking plate (ORIF), or arthroplasty (all p < 0.025), and to allow earlier unrestricted use of the extremity following IMN and arthroplasty (p = 0.001, p = 0.021 respectively). OT were more likely to consider operating on a PHF if there was contralateral upper extremity injury or need of the injured arm for work or activities of daily living (all p < 0.026). The subspecialties did not differ significantly on factors affecting their postoperative protocols. OT preferred IMN and SE surgeons preferred rTSA for allowing immediate unrestricted postoperative weight bearing, ROM, or lifting (all p < 0.001).
UNASSIGNED: There are significant differences in postoperative protocols between trauma and SE surgeons when treating PHFs. Postoperative protocols should be further studied to balance surgical outcomes and the risks of functional decline when treating patients with PHFs.
摘要：
■肱骨近端骨折（PHFs）可导致老年和多发性创伤患者的功能下降。PHF的治疗是从业者之间许多争论和差异很大的领域。
■我们调查了骨科创伤（OT）和肩肘部（SE）外科医生，以评估使用切开复位内固定术（ORIF）治疗急性PHF时术后方案的差异，髓内钉（IMN），或半或反向肩关节成形术（rTSA）。
■我们在2018年8月至2019年4月期间向三个OT和SE协会分发了一项基于网络的调查。问题包括实践特征，负重的标准术后方案，提升,和治疗方式的运动范围(ROM)，以及影响模态和术后方案决策的因素。我们比较了亚专业。
■239名外科医生[100（42.2%）OT，118（49.8%）SE]完成了调查。OT更有可能允许即时ROM，提升,髓内钉（IMN）后的承重，采用锁定钢板（ORIF）的切开复位内固定，或关节成形术（所有p<0.025），并允许IMN和关节成形术后更早不受限制地使用四肢（分别为p=0.001，p=0.021）。如果对侧上肢受伤或需要受伤的手臂进行工作或日常生活活动，则OT更有可能考虑对PHF进行手术（所有p<0.026）。亚专科在影响其术后方案的因素上没有显着差异。OT首选IMN和SE外科医生首选rTSA，以允许立即不受限制的术后负重，ROM,或提升(所有p<0.001)。
■在治疗PHF时，创伤和SE外科医生的术后方案存在显着差异。在治疗PHFs患者时，应进一步研究术后方案，以平衡手术结果和功能下降的风险。
■我们调查了骨科创伤（OT）和肩肘部（SE）外科医生，以评估使用切开复位内固定术（ORIF）治疗急性PHF时术后方案的差异，髓内钉（IMN），或半或反向肩关节成形术（rTSA）。
■我们在2018年8月至2019年4月期间向三个OT和SE协会分发了一项基于网络的调查。问题包括实践特征，负重的标准术后方案，提升,和治疗方式的运动范围(ROM)，以及影响模态和术后方案决策的因素。我们比较了亚专业。
■239名外科医生[100（42.2%）OT，118（49.8%）SE]完成了调查。OT更有可能允许即时ROM，提升,髓内钉（IMN）后的承重，采用锁定钢板（ORIF）的切开复位内固定，或关节成形术（所有p<0.025），并允许IMN和关节成形术后更早不受限制地使用四肢（分别为p=0.001，p=0.021）。如果对侧上肢受伤或需要受伤的手臂进行工作或日常生活活动，则OT更有可能考虑对PHF进行手术（所有p<0.026）。亚专科在影响其术后方案的因素上没有显着差异。OT首选IMN和SE外科医生首选rTSA，以允许立即不受限制的术后负重，ROM,或提升(所有p<0.001)。
■在治疗PHF时，创伤和SE外科医生的术后方案存在显着差异。在治疗PHFs患者时，应进一步研究术后方案，以平衡手术结果和功能下降的风险。
