Effect of triamcinolone acetonide on stiffness after surgical treatment of proximal humerus fractures: a randomized cont
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TRAUMA SURGERY
Effect of triamcinolone acetonide on stiffness after surgical treatment of proximal humerus fractures: a randomized controlled study Yang‑Soo Kim1 · Kyoung‑Geun Lee1 · Hyo‑Jin Lee1 Received: 2 September 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction The primary aim of this study was to determine the effectiveness and safety of an intraarticular triamcinolone injection for the treatment of stiffness after the operative treatment of proximal humerus fractures. Materials and methods 88 patients who underwent plate fixation for proximal humerus fractures were enrolled. The patients were randomly divided into two groups, with Group I receiving a glenohumeral injection of triamcinolone 8 weeks postoperatively and Group II receiving no injection postoperatively. Outcomes were measured and compared based on the range of motion (ROM) and functional scores. Follow-up outcomes were assessed at initial, 3, 6 and 12 months postoperatively and at the last follow-up. Shoulder trauma series were taken at every visit to evaluate the fracture healing. The mean follow-up period was 25.37 (± 3.85) months Group I and 24.24 (± 6.23) months for group II. Results In both groups, the final outcome of the ROM and functional outcome was significantly better at last F/U than at postoperative 8 weeks. Group I had significantly better results than Group II at postoperative 3 and 6 month in terms of forward flexion, external rotation, and VAS for pain. Also, Group I showed better performance in terms of ASES and Constant score at postoperative 3 months. The fracture union rate did not differ between Groups I and II. Conclusions Postoperative glenohumeral injection of triamcinolone is a safe and effective treatment modality for shoulder stiffness after internal fixation of proximal humerus fractures during the early period of rehabilitation. Keywords Proximal humerus · Fracture · Plate fixation · Stiffness · Triamcinolone acetonide
Introduction Proximal humerus fractures are among the most common fractures, especially in older individuals with poor bone quality. They are the third most common fracture, accounting for 5% of all fractures, and their incidence is increasing rapidly with increasing life expectancy [5]. Most proximal humerus fractures are amenable to nonoperative treatment, and excellent results have been achieved [2, 6, 11, 15]. * Hyo‑Jin Lee [email protected] Yang‑Soo Kim [email protected] Kyoung‑Geun Lee [email protected] 1
Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 505 Banpo‑dong, Seocho‑gu, Seoul 137‑701, Korea
However, surgical treatment is recommended for displaced fractures, which are challenging to manage. Due to the unique anatomical features of the proximal humerus, including multiple tendon attachments and close proximity to the shoulder joint, complications associated with proximal humerus fractures have always been of great concern, and postoperative management has been cha
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