Abstract
Objective: To evaluate the functional outcome of the shoulder following Neer reconstruction with a conservative rehabilitation regime.
Background data: Fractures of the proximal humerus following major or minor trauma are very common. The management of 3 and 4 part fractures of the shoulder with or without dislocation presents a challenging problem to the Orthopaedic Surgeon.
Neer reconstruction remains a gold-standard operation.
Standard rehabilitation regime is early mobilization to prevent the development of stiffness of the shoulder. However, an aggressive early rehabilitation may lead to non-healing of the greater tuberosity.
Methods: Between Dec 96 to Jun 03, 40 patients with three or four part fracture of shoulder underwent Neer reconstruction and a conservative rehabilitation regime at our centre (age range of 39–87 with a mean of 66). Patients were kept in a sling for 3 – 4 weeks before physiotherapy was commenced. They were reviewed at least 1 year postoperatively for assessment of pain and range of movement. X-Rays were taken to investigate union of the greater tuberosity. For the purpose of this study all patients were recalled and reassessed with Constant-Murley scoring system.
Results: Three patients died after the one year review, one patient lost to follow up. In 12.8% of the patients (mainly elderly, with mean age of 78.8) the greater tuberosity failed to heal. In those who the greater tuberosity healed mean elevation was more than 130, and mean external rotation was 40.
Conclusion: Postoperative immobilization did not result in excessive stiffness and excellent functional results were achieved, especially in those younger than 70 years of age. However tuberosity union could not be guarantied in very old patients.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
