Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture. A randomized controlled trial.

BACKGROUND: There have been few randomized controlled trials evaluating nonoperative treatment of proximal humeral fractures. To investigate shortening the period of dependence, we assessed the feasibility and efficacy of early mobilization of the shoulder (within three days after the fracture) in comparison with those of conventional three-week immobilization followed by physiotherapy. METHODS: We randomly assigned seventy-four patients with an impacted proximal humeral fracture to receive early passive mobilization or conventional treatment. The primary outcome was the overall shoulder functional status (as measured with the Constant score) at three months. The secondary outcomes were the Constant score at six weeks and at six months, the change in pain (on a visual analog scale), and the active and passive range of motion. RESULTS: At three months and at six weeks, the early mobilization group had a significantly better Constant score than did the conventional-treatment group (between-group difference, 9.9 [95% confidence interval, 1.9 to 17.8] [p = 0.02] and 10.1 [95% confidence interval, 2.0 to 18.1] [p = 0.02], respectively) and better active mobility in forward elevation (between-group difference, 12.0 [95% confidence interval, 1.7 to 22.4] [p = 0.02] and 28.1 [95% confidence interval, 7.1 to 49.1] [p = 0.01], respectively). At three months, the early mobilization group had significantly reduced pain compared with the conventional-treatment group (between-group difference, 15.7 [95% confidence interval, 0.52 to 30.8] [p = 0.04]). No complications in displacement or nonhealing were noted. CONCLUSIONS: Early mobilization for impacted nonoperatively treated proximal humeral fractures is safe and is more effective for quickly restoring the physical capability and performance of the injured arm than is conventional immobilization followed by physiotherapy.

[Uncommon aetiology of peroneal compartment syndrome]. / Une étiologie peu courante de syndrome des loges de la jambe.

Compartment syndromes are well recognized following major trauma. However, although uncommon, they may occur following athletic activity. We report a case of acute exertional peroneal compartmental syndrome in a 32-year-old that developed following horse riding. Because of the ignorance of pathology, a regional analgesia was carried out resulting in delayed diagnosis. Postoperative electromyography showed the absence of a fibula nerve compound action potential. At one-year follow-up visit following decompressive fasciotomy, muscular strength of the muscles of the anterior tibial compartment almost returned to normal. The presentation of this case of compartmental syndrome following horse riding allows to discuss the place of the regional anaesthesia. Because this anaesthesia technique can delay the diagnosis and the surgical treatment, it should not be used in first intention in the treatment of severe pain associated with compartmental syndrome.