F. Fayad

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.

398 SPLINT FOR BASE OF THUMB OSTEOARTHRITIS: A 12 MONTH RANDOMIZED CONTROLLED STUDY

Purpose: Splints for base of the thumb osteoarthritis (OA) are recommended in international guidelines but evidence for their efficacy in randomized trials are missing. The objective was to assess the efficacy and acceptability of splints for base of the thumb OA. Methods: Study design: Randomized controlled trial Setting: Two tertiary care hospitals in France Patients: 109 (94 women) patients with base of thumb carpometacarpal joint OA Intervention: 56 patients received custom-made neoprene splint and usual care (intervention) and 53 usual care (control) Outcome measures: Primary outcome was pain assessed on Visual Analog Scale (VAS, range 0-100) at 12 month follow-up. Secondary outcome measures were pain at 1 and 6 month, disability assessed by the Cochin Hand Function Scale (CHFS, range 0-90) and pinch strength at 1, 6, and 12 month. Intentionto-treat analyses were performed. Results: Pain at 12 month follow-up had significantly decreased in both groups (from 45.5±20.0mm to 23.6±22.8mm in intervention group, p= 0.0001, and from 47.7±20.0 to 39.2±24.2, p=0.02 in control group), and an inter-group difference was observed (-22.1±25.7 in intervention, and -8.8±25.2 in control group, p=0.006). Pain inter-group difference was also observed at 6 month but not at 1 month. Disability at 12 month was not significantly decreased in the intervention group (-2.0±12.9, p=0.19) but was significantly increased in the control group (3.4±11.3, p=0.04), and an inter-group difference was observed (p=0.03). Pinch strength was not modified in intervention and control group. In the intervention group, 86% of patients wore their splint at least 5 nights a week at 12 month and no adverse effect was observed. Conclusions: Our results suggest that splints are useful, safe, and acceptable for patients with thumb carpometacarpal joint OA.