Kinematic analysis of upper limb fractures: Insights for rehabilitation strategies.

Abstract

Upper limb fractures significantly alter movement, impacting function and recovery. Three-dimensional motion analysis allows precise assessment of these changes. Sixty patients were divided into four groups: shoulder, elbow, wrist fractures, and controls. Functional assessment was performed using the DASH questionnaire, followed by three-dimensional kinematic analysis with eight Oqus 300 cameras and 14 reflective markers on the thorax, scapula, humerus, forearm, and hand. The Acromion Marker Cluster method was used for accurate scapular tracking. Tasks analyzed included hand on shoulder, hand on back, and hand on neck. All measured variables are expressed in degrees. The analysis focused on the differences in maximum joint angles for each degree of freedom across the tasks. These differences were assessed using MANOVA, followed by ANOVAs and Tukey's post hoc test when applicable. Significant kinematic differences were observed between the fracture groups and the control group across all tasks. Shoulder fracture patients exhibited the greatest reductions in humeral flexion and abduction. Elbow fracture patients showed the most restricted elbow flexion. Wrist fracture patients presented significantly reduced radial/ulnar deviation. These movement impairments were observed across all tasks, with the most pronounced limitations seen in the hand-to-shoulder task. Effect sizes (η²) indicated clinically meaningful impacts, particularly for shoulder and wrist movements. This study reveals distinct kinematic alterations following upper limb osteosynthesis, emphasizing the need for individualized rehabilitation strategies addressing these specific movement impairments to optimize recovery.