<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2306-4102</journal-id>
<journal-title><![CDATA[Acta ortopédica mexicana]]></journal-title>
<abbrev-journal-title><![CDATA[Acta ortop. mex]]></abbrev-journal-title>
<issn>2306-4102</issn>
<publisher>
<publisher-name><![CDATA[Colegio Mexicano de Ortopedia y Traumatología A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2306-41022022000100014</article-id>
<article-id pub-id-type="doi">10.35366/106754</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Costo médico directo de la rehabilitación tardía en trabajadores con fractura proximal de húmero de manejo conservador]]></article-title>
<article-title xml:lang="en"><![CDATA[Direct medical cost of late rehabilitation in workers with conservatively managed proximal humerus fracture]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Navarrete-Peñaloza]]></surname>
<given-names><![CDATA[BI]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hernández-Amaro]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Mexicano del Seguro Social Unidad Médica de Alta Especialidad (UMAE) «Dr. Victorio de la Fuente Narváez» Unidad de Medicina Física y Rehabilitación Norte]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>Mexico</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto Mexicano del Seguro Social (IMSS) Unidad Médica de Alta Especialidad (UMAE) «Dr. Victorio de la Fuente Narváez» ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>Mexico</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>02</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>02</month>
<year>2022</year>
</pub-date>
<volume>36</volume>
<numero>1</numero>
<fpage>14</fpage>
<lpage>19</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2306-41022022000100014&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2306-41022022000100014&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2306-41022022000100014&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción:  Ochenta por ciento de las fracturas de húmero proximal son no desplazadas o mínimamente desplazadas y estables. La recomendación internacional de tratamiento es de uno conservador. La inmovilización de la extremidad conlleva riesgo de rigidez, dolor y disminución de función. Actualmente se están empleando programas de rehabilitación con movilización precoz del hombro lesionado dentro de la primera semana postfractura, con evidencia de recuperación funcional y laboral precoces y con ausencia de riesgo para desplazamiento de fragmentos. Sin embargo, en nuestro país, estos pacientes inician la rehabilitación de forma tardía, lo que conlleva un retardo en la recuperación de funcionalidad y retardo en reincorporación laboral, traduciendo incremento en costos. Al momento no existe un referente nacional del costo que implica esta rehabilitación de inicio tardío.  Material y métodos:  De una muestra no probabilística por conveniencia, se analizaron expedientes de 52 pacientes, atendidos en el período de Enero a Diciembre de 2019. Los criterios de inclusión fueron trabajadores con diagnóstico de fractura de húmero proximal, manejo conservador; criterios de exclusión fueron lesión de nervio periférico, fractura agregada o postoperados.  Resultados:  La media del costo médico directo fue $19,090.69 pesos mexicanos, con relación directamente proporcional a los días de estancia en la unidad y de incapacidad.  Conclusión:  La rehabilitación tardía conlleva más días de incapacidad que las recomendadas por las guías con base en la carga de trabajo, por ende, mayor costo.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Eighty percent of the Proximal humerus fractures are not displaced or minimally displaced and stable. The international treatment recommendation is conservative. Immobilization of the limb carries risk of stiffness, pain and decreased function. Currently being used rehabilitation programs with early mobilization of the injured shoulder within the first week post-fracture, with evidence of early functional and labor recovery and with no risk for displacement of fragments. However, in our country, these patients start rehabilitation late, which leads to a delay in the recovery of functionality and delay in returning to work, translating into increased costs. At the moment there is no national benchmark for the cost of this late-onset rehabilitation.  Material and methods:  From a non-probabilistic sample for convenience, were analyzed records of 52 patients, treated in the period from January to December 2019. Inclusion criteria were workers diagnosed with a proximal humeral fracture, conservative management; exclusion criteria were peripheral nerve injury, aggregate fracture or surgically treated.  Results:  The mean direct medical cost was $19,090.69 Mexican pesos, directly proportional to the days of stay in the unit and disability.  Conclusion: Late rehabilitation leads to more days of disability than recommended by the based guidelinesin the workload, therefore, higher cost.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Rehabilitación]]></kwd>
<kwd lng="es"><![CDATA[tardía]]></kwd>
<kwd lng="es"><![CDATA[fracturas]]></kwd>
<kwd lng="es"><![CDATA[proximal húmero]]></kwd>
<kwd lng="es"><![CDATA[costo]]></kwd>
<kwd lng="en"><![CDATA[Rehabilitation]]></kwd>
<kwd lng="en"><![CDATA[late]]></kwd>
<kwd lng="en"><![CDATA[fractures]]></kwd>
<kwd lng="en"><![CDATA[proximal humerus]]></kwd>
<kwd lng="en"><![CDATA[cost]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Núñez-Gómez,]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
<name>
<surname><![CDATA[Hernández-Álvarez,]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Pérez-Atanasio,]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Torres-González,]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Águila-Ledesma]]></surname>
<given-names><![CDATA[IR]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Patrón de tratamiento en pacientes adultos mayores con fractura de húmero proximal en tres o cuatro fragmentos en un centro de referencia de una economía emergente]]></article-title>
<source><![CDATA[Acta Ortop Mex]]></source>
<year>2015</year>
<volume>29</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>207-11</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Court-Brown]]></surname>
<given-names><![CDATA[CM]]></given-names>
</name>
<name>
<surname><![CDATA[Caesar]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Epidemiology of adult fractures: a review]]></article-title>
<source><![CDATA[Injury]]></source>
<year>2006</year>
<volume>37</volume>
<page-range>691-7</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Launonen]]></surname>
<given-names><![CDATA[AP]]></given-names>
</name>
<name>
<surname><![CDATA[Lepola]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Saranko]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Epidemiology of proximal humerus fractures]]></article-title>
<source><![CDATA[Arch Osteoporos]]></source>
<year>2015</year>
<volume>10</volume>
<page-range>209</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Handoll]]></surname>
<given-names><![CDATA[HH]]></given-names>
</name>
<name>
<surname><![CDATA[Brorson]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Interventions for treating proximal humeral fractures in adults]]></article-title>
<source><![CDATA[Cochrane Database Syst Rev]]></source>
<year>2015</year>
<numero>11</numero>
<issue>11</issue>
<page-range>CD000434</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Launonen]]></surname>
<given-names><![CDATA[AP]]></given-names>
</name>
<name>
<surname><![CDATA[Lepola]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Flinkkila]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Laitinen]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Paavola]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Malmivaara]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Treatment of proximal humerus fractures in the elderly: a systemic review of 409 patients]]></article-title>
<source><![CDATA[Acta Orthop]]></source>
<year>2015</year>
<volume>86</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>280-5</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Handoll]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Brealey]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Rangan]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Keding]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Corbacho]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Jefferson]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The ProFHER (PROximal Fracture of the Humerus: Evaluation by Randomisation) trial - a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and cost-effectiveness of surgical compared with non-surgical treatment for proximal fracture of the humerus in adults]]></article-title>
<source><![CDATA[Health Technol Assess]]></source>
<year>2015</year>
<volume>19</volume>
<numero>24</numero>
<issue>24</issue>
<page-range>1-280</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hodgson]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Proximal humerus fracture rehabilitation]]></article-title>
<source><![CDATA[Clin Orthop Relat Res]]></source>
<year>2006</year>
<volume>442</volume>
<page-range>131-8</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lungberg]]></surname>
<given-names><![CDATA[BJ]]></given-names>
</name>
<name>
<surname><![CDATA[Svenungson-Hartwig]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Wikmark]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Independent exercises versus physiotherapy in nondisplaced proximal humeral fractures]]></article-title>
<source><![CDATA[Scand J Rehabil Med]]></source>
<year>1979</year>
<volume>11</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>133-6</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bertoft]]></surname>
<given-names><![CDATA[ES]]></given-names>
</name>
<name>
<surname><![CDATA[Lundh]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Ringqvist]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Physiotherapy after fracture of the proximal end of the humerus. Comparison between two methods]]></article-title>
<source><![CDATA[Scand J Rehabil Med]]></source>
<year>1984</year>
<volume>16</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>11-6</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aguado]]></surname>
<given-names><![CDATA[HJ]]></given-names>
</name>
<name>
<surname><![CDATA[Ariño]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Moreno-mateo]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Bustinza]]></surname>
<given-names><![CDATA[EY]]></given-names>
</name>
<name>
<surname><![CDATA[Simón-pérez]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez-Zarzuela]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Does an early mobilization and immediate home- based self-therapy exercise program displace proximal humeral fractures in conservative treatment? Observational study]]></article-title>
<source><![CDATA[J Shoulder Elb Surg]]></source>
<year>2018</year>
<volume>27</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>2021-9</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lefevre-Colau]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Babinet]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Fayad]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Fermanian]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Anract]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Roren]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Immediate mobilization compared with conventional immobilization for the impacted nonoperatively treated proximal humeral fracture. A randomized controlled trial]]></article-title>
<source><![CDATA[J Bone Joint Surg Am]]></source>
<year>2007</year>
<volume>89</volume>
<numero>12</numero>
<issue>12</issue>
<page-range>2582-90</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bruder]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Shields]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Dodd]]></surname>
<given-names><![CDATA[KJ]]></given-names>
</name>
<name>
<surname><![CDATA[Taylor]]></surname>
<given-names><![CDATA[NF]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prescribed exercise programs may not be effective in reducing impairments and improving activity during upper limb fracture rehabilitation: a systematic review]]></article-title>
<source><![CDATA[J Physiother]]></source>
<year>2017</year>
<volume>63</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>205-20</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Carbone]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Razzano]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Albino]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Mezzoprete]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Immediate intensive mobilization compared with immediate conventional mobilization for the impacted osteoporotic conservatively treated proximal humeral fracture: a randomized controlled trial]]></article-title>
<source><![CDATA[Musculoskelet Surg]]></source>
<year>2017</year>
<volume>101</volume>
<numero>^s2</numero>
<issue>^s2</issue>
<supplement>2</supplement>
<page-range>137-43</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Frank]]></surname>
<given-names><![CDATA[FA]]></given-names>
</name>
<name>
<surname><![CDATA[Niehaus]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Borbas]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Eid]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Risk factors for secondary displacement in conservatively treated proximal humeral fractures]]></article-title>
<source><![CDATA[Bone Joint J]]></source>
<year>2020</year>
<volume>102</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>881-9</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
