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CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2024; 65(01): e1-e8
DOI: 10.1055/s-0043-1777433
Artículo Original | Original Article

Fracturas de la extremidad proximal de húmero en tres y cuatro fragmentos en el anciano: ¿Tratamiento conservador o artroplastia reversa?

Artikel in mehreren Sprachen: español | English
María del Coro Solans Lopez 
1   Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
,
Carlos Rodríguez Conde
1   Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
,
José Carlos Álvarez González 
1   Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
,
Fausto López Mombiela
1   Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
,
Ángel Pérez Martín
1   Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
,
Mikel Aburto Bernardo
1   Unidad de Cirugía de Hombro y Codo, Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Resumen

Objetivo Comparar los resultados funcionales obtenidos en dos cohortes de pacientes ancianos tratados de forma quirúrgica (artroplastia reversa de hombro) versus tratamiento conservador.

Material y Métodos Estudio ambispectivo, no aleatorizado. Se incluyeron pacientes de 75 años o más, 15 tratados de forma quirúrgica y 16 siguieron tratamiento conservador. Seguimiento mínimo de 12 meses. A los 3, 6 y 12 meses de la fractura evaluamos las escalas ASES, Constant-Murley and Disabilities of the Arm, Shoulder and Hand score (DASH) y EVA. Además evaluamos los resultados radiológicos y las complicaciones.

Resultados No encontramos diferencias significativas para las escalas ASES, DASH, ni EVA .El grupo tratado de forma quirúrgica obtuvo a los 12 meses una puntuación media en la escala Constant mayor, diferencia estadísticamente significativa(75.1 +/-10.3 vs. 51.9 +/-12.4 p = 0.001). Además presentaban mayor rango de movilidad para flexión y rotación externa (128.9 +/-17 versus 99.3 +/-20.1 p = 0.001, and 35.7 +/-13.9 vs. 23.4 +/-15.5 p = 0.032). El 43% de los pacientes tratados mediante artroplastia reversa presentaban tuberosidades normoposicionadas y mejores resultados en las escalas versus pacientes con tuberosidades ausentes o malposicionadas. El grupo sometido a cirugía no presentó mayor tasa de complicaciones.

Conclusiones El tratamiento conservador en las fracturas de EPH en tres y cuatro fragmentos en pacientes ancianos ofrece buenos resultados en cuanto a dolor y funcionalidad en la mayoría de pacientes. Falta por definir qué pacientes por tener alta demanda funcional serían candidatos a tratamiento quirúrgico de entrada.

Nivel de Evidencia Nivel III

Palabras Clave

fractura extremidad proximal húmero - anciano - tratamiento conservador - artroplastia reversa de hombro


Publikationsverlauf

Eingereicht: 02. August 2022

Angenommen: 21. November 2023

Artikel online veröffentlicht:
03. Mai 2024

© 2024. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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