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

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

Publication History

Received: 02 August 2022

Accepted: 21 November 2023

Article published online:
03 May 2024

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