Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture. A randomized controlled trial. Conservative management of minimally displaced isolated fractures of the ulnar shaft. [Pure posterior luxation of the elbow in adults: immobilization or early mobilization. A randomized prospective study of 50 cases]. Elastic stable intramedullary nailing versus nonoperative treatment of displaced midshaft clavicular fractures-a randomized, controlled, clinical trial. Early mobilization in a removable cast compared with immobilization in a cast after operative treatment of ankle fractures: a prospective randomized study. Early mobilization in the treatment of Colles' fracture: a 3 year prospective study. Early mobilisation versus immobilisation of surgically treated ankle fractures. Prospective randomised control trial. Early mobilisation of Colles' fractures. A prospective trial. Early versus late mobilization after hemiarthroplasty for proximal humeral fractures.
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.
                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.
                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.
                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. The purpose of this prospective study was to compare three different ways of conservative management of isolated fractures of the ulnar shaft: immediate mobilisation, below-elbow plaster cast and above-elbow plaster cast immobilisation. Over a 24-month period, 102 minimally displaced isolated fractures of the distal two-thirds of the ulnar shaft were treated on an outpatient basis. Thirty-two fractures were immobilised with an above-elbow plaster cast for 3 weeks and a below-elbow plaster cast for an additional 3 weeks. Thirty-six fractures were immobilised with a below-elbow plaster cast for 6 weeks. The remaining 34 fractures were managed with immediate mobilisation. Radiological healing, range of motion of the wrist, and pain were assessed. Results were good and were comparable in terms of healing, time to healing, pain and range of motion of the wrist. Pure posterior dislocation of the elbow is frequent in young subjects. The objective of treatment must be to reduce the dislocation and avoid complications, the most frequent being stiffness, but also elbow instability. The objective of this prospective study was to evaluate the functional and anatomical characteristics of two treatment modalities: plaster immobilization and early mobilization.
                50 cases of pure posterior dislocation of the elbow were included in a prospective study and randomized to two groups: Group I: twenty six cases were treated by reduction under general anaesthesia and plaster immobilization for three weeks, followed by rehabilitation. Group II: twenty four cases were treated by reduction under general anaesthesia, followed by early mobilization.
                We evaluated our results in terms of loss of amplitude of elbow movement (particularly extension), stiffness, instability, relapses, pain and ossification. This study demonstrated better recovery of elbow function in patients treated by early mobilization: 96% of good results with recovery of normal extension in group II versus 81% of cases in group I. Stiffness was observed in 19% of patients in group I versus 4% in group II; this difference was very significant. Comparison of pain revealed no significant difference and no relapses, instability or ossifications were observed in either of the two groups.
                Early mobilization is superior to plaster immobilization, as it allows recovery of better quality elbow function without inducing instability or recurrence. To compare elastic stable intramedullary nailing (ESIN) with nonoperative treatment of fully displaced midshaft clavicular fractures in adults.
                The study was a randomized, controlled, clinical trial.
                Level 1 trauma center.
                Sixty patients between 18 and 65 years of age participated and completed the study. They were randomized to either operative or nonoperative treatment with a 2-year follow-up.
                Thirty patients were treated with a simple shoulder sling and 30 patients with ESIN within 3 days after trauma.
                Complications after operative and nonoperative treatments, Disabilities of the Arm, Shoulder and Hand (DASH) score and Constant Shoulder Score for outcome measurement, and clavicular shortening.
                Fracture union was achieved in all patients in the operative group, whereas nonunion was observed in 3 of 30 patients of the nonoperative group. Two symptomatic malunions required corrective osteotomy in the nonoperative group. Medial nail protrusion occurred in 7 cases in the operative group. Implant failure with revision surgery was necessary in 2 patients after an additional adequate trauma. DASH scores were lower in the operative group throughout the first 6 months and 2 years after trauma, with a significant difference during the first 18 weeks. Constant scores were significantly higher after 6 months and 2 years after intramedullary stabilization. Patients in the operative group showed a significant improvement of posttraumatic clavicular shortening; they were also more satisfied with cosmetic appearance and overall outcome.
                ESIN of displaced midshaft clavicular fractures resulted in a lower rate of nonunion and delayed union, a faster return to daily activities, and a better functional outcome. Clavicular shortening was significantly lower, and overall satisfaction was higher in the operative group. The aim of operative treatment for ankle fractures is to allow early movement after internal fixation. The hypothesis of this study was that early mobilization would improve functional recovery in patients after surgery for ankle fractures.
                In a prospective randomized controlled study, 66 consecutive patients with ankle fractures that required open reduction and internal fixation (ORIF) were assigned to one of two postoperative regimens: immobilization in a nonweightbearing below-knee cast or early mobilization in a removable cast. Four patients were excluded from the study, leaving 62 for review.
                Patients who had early mobilization in a removable cast had higher functional scores (Olerud-Molander and AOFAS) at 9 and 12 weeks postoperatively. They also returned to work earlier (67 days) compared with those treated in nonweightbearing below-knee cast (95 days), p<0.05. There was no statistical difference in Quality of Life (SF-36 Questionnaire) at 6 months between the two groups. We had an approximately 10% postoperative infection trend (one superficial and two deep) in the early mobilization group.
                Despite the overall short-term benefit of early mobilization, we had three patients in the early mobilization group who had wound complications. Both the surgeon and patient should be aware of the higher risk of wound complications associated with this treatment, and thus the accelerated rehabilitation protocol should be individualized. Ninety consecutive women with unilateral Colles' fractures were randomized into two different treatment groups. The control group was treated for 5 weeks in conventional short-arm, below the elbow plaster of Paris casts. The other group (N = 45) was treated similarly in plaster casts for 3 weeks and then had flexible casting applied for the remaining 2 weeks which allowed for early joint mobilization. Functional recovery was assessed by measuring grip strength and joint mobility at intervals over the 3 years. Radiographic and overall assessments were also made during 3 year course of study. Virtually all patients reported greater comfort after switching to the flexible casting. Mean grip scores and joint mobilities were higher at all time points with early mobilization, reaching levels of statistical significance at 6 months for grip score and at 3 months for joint mobility. By 3 years most differences between treatment groups had resolved. We found no evidence that early mobilization was detrimental to recovery. We conclude that early mobilization is a satisfactory treatment option for Colles' fracture, and may, in fact, hasten functional recovery. In a randomised prospective controlled trial of 52 patients aged 16 to 65 we compared early non-weightbearing ankle mobilisation with ankle immobilisation following surgical treatment of bimalleolar ankle fractures. At 3 months there was no significant difference between the two groups in the range of ankle movements or pain. There was however a significant difference in the gait pattern with a higher proportion of cases in the early ankle mobilisation group having a symmetrical gait (P = 0.0001). The results of a prospective controlled trial of early mobilisation of Colles' fractures in the elderly are presented. Early mobilisation produced less pain and a stronger grip. It did not lead to any greater loss of reduction of the fracture. However, there was no significant improvement in the final range of movement of the wrist. Immobilisation of the wrist for six weeks in plaster is extremely inconvenient for the elderly living alone and the patients greatly appreciated the reduction of this period of time to a minimum. This randomized controlled trial compares 2 mobilization regimens after shoulder hemiarthroplasty for acute 3- and 4-part fractures. The aim was to establish whether the length of immobilization plays a role in the functional outcome, tuberosity healing, and subsequent range of motion. The same prosthesis and surgical technique were used. We recruited 59 patients into the study; 31 were randomized to early (2 weeks) mobilization and 28 to late (6 weeks) mobilization. Greater tuberosity migration was assessed with a series of radiographs, and the functional outcome was assessed with the Constant Shoulder Assessment and Oxford shoulder scores. Of the patients, 49 (mean age, 70 years) met the inclusion criteria and were followed up for 12 months. Greater tuberosity migration occurred in 3 cases in the early mobilization group and once in the late mobilization group (P > .10). There was no significant difference in the Constant Shoulder Assessment and Oxford scores between the 2 groups. Although there was a decreased incidence of tuberosity migration in the group undergoing late mobilization, this was not statistically significant.
There is a lack of robust evidence to inform on the timing of mobilisation, and specifically on the use of early mobilisation, after non-surgical or surgical treatment for adults with elbow fractures.
There is a need for high quality, well-reported, adequately powered, randomised controlled trials that compare early versus delayed mobilisation in people with commonly-occurring elbow fractures, treated with or without surgery. Trials should use validated upper limb function scales, and assessment should be both short-term (to monitor recovery and early complications) and long-term (at least one year).