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. 2023 Oct;15(5):513-521.
doi: 10.1177/17585732221142505. Epub 2022 Dec 7.

The N-brace trial: Does arm position during immobilisation of proximal humerus fractures influence outcome - A preliminary study

Kishan Gokaraju  1 , Philip Ahrens  2 , Pascal Boileau  3 , Tobias Baring  4
Affiliations

The N-brace trial: Does arm position during immobilisation of proximal humerus fractures influence outcome - A preliminary study

Kishan Gokaraju et al. Shoulder Elbow. 2023 Oct.

Abstract

Background: Traditional initial management of proximal humerus fractures (PHF) involves arm immobilisation in a simple sling (SS) in an internally rotated position. We believe this risks fracture displacement and imbalance of soft tissues, encouraging malunion and stiffness. A neutral-rotation brace (NRB) maintains an arm position which may prevent this, leading to quicker and superior recovery.

Methods: We randomised patients with two- to four-part PHF into 4 weeks of immobilisation with either a SS or NRB, independent of surgery. Range of motion (ROM), subjective shoulder value (SSV), DASH, Constant-Murley (CMS) and Oxford Shoulder (OSS) scores were assessed at 6-weeks, 3-months and 1-year post-injury.

Results: The SS group included 11 patients vs 9 in the NRB group. At final follow-up, the SS and NRB groups had mean DASH scores of 42 vs 35, OSS 42 vs 46, CMS 71 vs 86, SSV 84% vs 92%, respectively. ROM was superior with the NRB (elevation 159°, ER 47° and IR score 8 vs 140°, 37° and 7 with SS).

Conclusions: Despite being a small series, our results demonstrate a trend towards NRB providing better outcomes. This feasibility study supports the need for a larger multi-centre randomised controlled trial comparing these immobilisation methods for PHF.

Keywords: brace; neutral rotation; proximal humerus; proximal humerus fracture; shoulder; sling.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
A. Neutral-rotation brace viewed from face-on. B. Neutral-rotation brace viewed from the affected side.
Figure 2
Figure 2
Graph demonstrating CMS results in the SS and NB groups.
Figure 3.
Figure 3.
Graph demonstrating SSV results in the SS and NB groups
Figure 4.
Figure 4.
Graph demonstrating DASH results in the SS and NB groups
Figure 5.
Figure 5.
Graph demonstrating OSS results in the SS and NB groups
Figure 6.
Figure 6.
Graph demonstrating elevation in degrees in the SS and NB groups
Figure 7.
Figure 7.
Graph demonstrating ER results in degrees in the SS and NB groups
Figure 8.
Figure 8.
Graph demonstrating IR in points (as per the CM scoring tool) in the SS and NB groups
See this image and copyright information in PMC

References

    1. Bell JE, Leung BC, Spratt KF, et al. Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly. J Bone Joint Surg Am 2011; 93: 121–131. - PMC - PubMed
    1. Court-Brown CM, Cattermole H, McQueen MM. Impacted valgus fractures (B1.1) of the proximal humerus. The results of non-operative treatment. J Bone Joint Surg Br 2002; 84: 504–508. - PubMed
    1. Roux A, Decroocq L, El Batti S, et al. Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res 2012; 98: 715–719. - PubMed
    1. Rangan A, Handoll H, Brealey S, et al. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus – the PROFHER randomized clinical trial. JAMA 2015; 313: 1037–1047. - PubMed
    1. Neer CS, 2nd. Displaced proximal humeral fractures. Part I. Classification and evaluation. J Bone Joint Surg Am 1970; 52: 1077–1089. - PubMed

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