dimecres, 9 de novembre de 2011

Decidir quan un tractament Q en fractures d'espatlla...

Interessant article:
Hemiarthroplasty versus nonoperative treatment ofdisplaced 4-part proximal humeral fractures in elderly patients: a randomized controlled trial.

Olerud, MDa,*, Leif Ahrengart, MD, PhDa, Sari Ponzer, MD, PhDa,Jenny Saving, MDa, Jan Tidermark, MD, PhDa,b.
aKarolinska Institutet, Department of Clinical Science and Education, Section of Orthopaedics, Stockholm S€oder Hospital,Sweden bDepartment of Orthopaedics, Capio St G€orans Hospital, Stockholm, Sweden

Background: The aim of the study was to report the 2-year outcome after a displaced 4-part fracture of the
proximal humerus in elderly patients randomized to treatment with a hemiarthroplasty (HA) or nonoperative
treatment.
Patients and Methods: We included 55 patients, mean age 77 (range, 58-92) years, 86% being women. Follow-up examinations were done at 4, 12, and 24 months. The main outcome measures were healthrelated quality of life (HRQoL) according to the EQ-5D and the DASH and Constant scores.

Results: At the final 2-year follow-up the HRQoL was significantly better in the HA group compared to the
nonoperative group, EQ-5D index score 0.81 compared to 0.65 (P¼.02). The results forDASHand pain assessment were both in favor of the HA group, DASH score 30 versus 37 (P ¼.25) and pain according to VAS 15 versus 25 (P ¼.17). There were no significant differences regarding the Constant score or range of motion (ROM). Both groups achieved a mean flexion of approximately 90-95º and a mean abduction of 85-90º.The need for additional surgery was low: 3 patients in the HA group and 1 patient in the nonoperative group.

Conclusion: The results of the study demonstrated a significant advantage in quality of life in favor of HA,
as compared to nonoperative treatment in elderly patients with a displaced 4-part fracture of the proximal
humerus. The main advantage of HA appeared to be less pain while there were no differences in ROM.

Level of evidence: Level I, Randomized Controlled Trial, Treatment Study.

2011 Journal of Shoulder and Elbow Surgery