In this article, I would like to talk about humerus fracture and outcome in adults and older.
The humerus, the bone of the second arm, is said to be more prone to fracture around the center, called the diaphysis, in adults, and slightly above the center, called the surgical neck, as we get older.There is no choice but to treat the fracture, but what method to choose is a matter of concern.In Japan, surgical treatment is the most common choice, although the preference seems to vary depending on the institution you visit.There is a question as to whether surgery is the right choice, since the degree of the fracture is different. However, I would like to introduce a review that may be helpful in deciding whether to use surgical or conservative methods.
The study
This is a review of 31 randomized studies with a total of 1941 participants.
One study compared 18 treatment modalities, and eight studies provided the best evidence, which investigated whether surgical treatment provides better results than non-surgical treatment for displaced fractures.Nine trials evaluated nonsurgical treatment of non-serious fractures.One trial found that wearing an arm sling was generally more comfortable than a bandage to tie up the trunk.There was some evidence that early rehabilitation (within one week), compared to delayed rehabilitation (after three weeks), reduced pain and hastened recovery from non-displaced fracture injuries.Two studies found weak evidence that many patients had more satisfactory outcomes when given adequate instructions for self-directed exercise.Eight studies, including 567 participants who sustained displaced fractures, compared surgical and nonsurgical treatments.Results from five of the studies showed no significant differences between the two approaches on patient-reported measures of function and quality of life at 6, 12, and 24 months.
There was also little difference in mortality between the two groups.
Patients who underwent surgical procedures had more adverse events than those who chose conservative treatment options, with twice as many people undergoing reoperation.
Twelve trials (744 patients) tested different surgical treatments.
There was weak evidence that there were differences in the incidence of complications and other problems between some of the surgical treatments.There was very limited evidence to suggest similar results for early versus delayed mobilization after surgical fixation or hemiarthroplasty.
Reviewer's conclusions
Compared with nonsurgical treatment, for people with displaced proximal humeral fractures involving the humeral neck, there is high or moderate quality evidence that surgery does not produce better results at 1 and 2 years after injury and is more likely to produce greater results the need for subsequent surgery. The evidence does not cover the treatment of two-part nodal fractures, youth fractures, high-energy trauma, or less common fractures such as fracture dislocations or split head fractures.
There is insufficient evidence from RCTs to inform a choice between different non-surgical, surgical, or rehabilitation interventions for these fractures.
Handoll HHG, Brorson S. Interventions for treating proximal humeral fractures in adults. Cochrane Database of Systematic Reviews 2015, Issue 11. No.: CD000434. DOI: 10.1002/14651858.CD000434.pub4.
Conclusion
The results of this review indicate that for fractures that are likely to occur commonly, there is no difference in outcome between conservative and surgical methods, such that even for displaced fractures, the risks of surgical methods are indicated.As judo therapists, we know that if the fracture is ideally healed, it may be possible to heal it without the use of hematopoietic treatment, but this result does not apply to fractures with multiple bone fragments.Even with these results, there are restrictions on who can treat fractures, and this is the work of doctors or judo therapists.
And while judo therapists may be able to provide emergency treatment, they cannot provide post-operative care without a doctor's approval, so it is doubtful that this is a review that can be practically used.
However, the choice of treatment is the patient's own, so careful judgment is necessary when visiting a hospital or other medical institution.
