The role of early mobilisation after nailing osteosynthesis of CT4 fractures

After centromedullary nailing (CMN) of 4-fragment cephalo-tuberosity (CT4) fractures of the upper end of the humerus (ESH), immobilisation of the shoulder is usual, although there is no scientific justification for this attitude or for the duration of immobilisation. The aim of this study was to assess the impact of the duration of immobilisation after ECM of CT4 fractures of the ESH on clinical and radiological results and the complication rate. The hypothesis was that early mobilisation was not associated with a worsening of results or an increase in the complication rate. All patients operated on for a CT4 ESH fracture by ECM in our centre between 2018 and 2022 were retrospectively included. 2 groups were formed according to the duration of post-operative immobilisation of the shoulder: 0 to 2 weeks (group A) and 3 to 6 weeks (group B). All patients had a clinical examination (range of motion and functional score) and X-rays of the shoulder at a minimum follow-up of 12 months. 29 patients with a mean age of 66 (39-98) years were included, 13 in group A and 16 in group B. The mean follow-up was 30 (12-60) months. Active joint ranges at last follow-up were: active anterior elevation 149.58° (80-180°) in group A versus 134.84 (60-180°) in group B (p=0.099); active external rotation elbow to body 45° (15-70°) in group A versus 42° (15-70°) in group B (p=0.6). The mean constant or absolute self-constant score was 78.29 for group A (45-100 points) versus 68.59 (45-96) for group B (p=0.0065). In terms of complications, group A had 2 cases of retractile capsulitis. In group B, there was 1 algodystrophy, 1 retractile capsulitis, 1 osteonecrosis of the humeral head and 1 pseudarthrosis. Early mobilisation of the shoulder after ECM of CT4 fractures of the ESH had no impact on clinical or radiological results, or on the rate of complication or secondary displacement.