Open subtypes 3 open subtypes 3 your digital gateway to expertise, education, and. Nonoperative proximal humeral fracture rehabilitation protocol general principles. Shared care plan eastbourne 023 414928 conquest 01424 757576 email esht. A proximal humerus fracture is the most common fracture of the shoulder, lying at the upper end of the humerus, or arm bone. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Rehabilitation programs for operative and nonoperative. Proximal humerus fracture is often seen in elderly population 1 and postmenopausal female. This normally takes between 612 weeks to unite heal. Fractures of this region are common both with highenergy. Return to normal function and motion may require 3 to 4 months overall goals. The most common cause of a proximal humerus fracture is falling over onto an outstretched hand. An environmental scan of canadian physiotherapy practice patterns published.
This protocol is for patients with nondisplaced proximal humerus fractures, or patients with proximal humerus fractures that have been surgically repaired. Rehabilitation programs for operative and nonoperative shoulder. Complications may include injury to an artery or nerve, and compartment syndrome the cause of a humerus fracture is usually physical trauma such as a fall. Pdf nonoperative treatment of proximal humerus fractures. Hemiarthroplastyorif proximal humerus fracture protocol general principles of rehabilitation for fractures treat the patient not the fracture move all joints that are not immobilized prevent disuse atrophy use gravity to assist in mobilizing a joint be aware of peripheral nerve palsy signs. A proximal humerus fracture is a break in the arm bone near the shoulder, or a broken shoulder. This is due to the trauma from the fracture and from the surgery. Proximal humerus fractures account for 6% of all fractures and are the third most common extremity fracture in the elderly population following hip and distal radius fractures. The incidence of proximal humerus fractures increases with age, and we observe a seasonal variation strongly favoring winter months. Postoperative protocols orif proximal humerus fractures general rehabilitation guidelines tuberosities are repaired and bony healing must occur before stress is applied to rotator cuff tendons precautions no external rotation past 40 deg for 6 weeks no active internal rotation for 6 weeks. Nonoperative proximal humeral fracture rehabilitation protocol. The incidence is approximately 70 per 100,0005, 6 and it will probably increase due to the association with age and osteoporosis710. Nonop proximal humerus fracture institute for orthopaedic surgery. While nondisplaced fractures can be managed conservatively, displaced.
Start stage 3 exercises once you can do stage 2 exercises with no pain. Bony healing occurs usually within 6 to 8 weeks in adults 3. Functional bracing of fractures of the shaft of the humerus. Maintain rom without displacing the proximal humerus fracture. Proximal humerus fracture postoperative orif jason dieterle, do considerations. Common symptoms pain bruising and swelling difficulty moving the shoulder apprehension or anxiety about movement what can i do to help my shoulder recover. Humerus fx orif protocol proximal, midshaft, or distal orif dr. Pdf rehabilitation of proximal humerus fractures a. Due to variable stability of the fracture, check for specifications and. Patient information proximal humeral fracture break in. Fractures of the proximal humerus are common injuries. Due to variable stability of the fracture, check for specifications and precautions ordered by the. Monteggia fracture of the proximal ulna with anterior dislocation of the radial head.
Orif proximal humerus rehabilitation program instructions. Proximal humerus fractures account for 5 % of all fractures, and they are. Symptoms include pain, swelling, and a decreased ability to move the shoulder. A humerus fracture is a break of the humerus bone in the upper arm. Nondisplaced means less than 1cm of displacement and less than 45 of angulation 2.
A proximal humerus fracture is a break of the upper part of the bone of the arm. In women 80 years and older the incidence is third only to fractures of the proximal femur and the distal. Proximal means it is the end of the bone that is closest to the body. A sling and swath, or velpeau with an axillary pad should be used when not doing physical therapy. The shoulder is a ball and socket joint and you have fractured just below the ball part. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf progress to full. This plate addresses complex fractures of the proximal humerus. Proximal humerus fracture shoulder 7 fracture care team. Proximal humerus fractures are common but debilitating injuries, which result in significant dysfunction for the patient and both diagnostic and treatment challenges for the physician. Most unstabledisplaced fractures or fractures with accompanying vascular insult require surgical intervention.
The aim of this study was to investigate the epidemiology of proximal humerus fractures. Bony healing occurs usually within 6 to 8 weeks in adults. Dont lift anything heavier than a cup of coffee for the first 6 weeks after surgery. Proximal humeral fracture postsurgical rehabilitation. Tuberosities are repaired and bony healing must occur before stress is applied to the rc tendons. Proximal humeral fractures dr hammonds protocol most of these fractures can be managed nonoperatively with a collar and cuff. The treatment of proximal humeral fracture in adults.
Proximal humerus fracture east sussex healthcare nhs trust. The fracture is also observed in children mostly following fall and young adults following direct impact, which results in fracture. Rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. General principles of rehabilitation for fractures. In the aging population, the proximal humerus fracture is the third most common osteoporotic fracture type after hip and distal radius fractures, accounting for 4% of all fractures. Phfs represent a signiicant health care problem, especially among the aging population. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints. The collar and cuff should be applied as per these photos you will note a safetypin is used to enable adjusting of the collar and cuff. The fall doesnt need to be from any great height, falling from a standing height.
Hemiarthroplastyorif proximal humerus fracture protocol. Rehabilitation programs for nonoperative humeral fractures. Due to variable stability of the fracture, check for specifications and precautions ordered by the orthopedist. A sarmiento, pb kinman, eg galvin, rh schmitt and jg phillips functional bracing of fractures of the shaft of the humerus this information is current as of january 22. A fracture occurs when the arm bone humerus is broken as a result of an accident such as a fall onto the arm. More than 70% of the patients that present with proximal humerus fracture are over 60 years of age and 75% are women. Microsoft word nonsurgical proximal humerus fracture protocol. This information will guide you through the next 6 weeks of your rehabilitation. It is best to space the exercise sessions out throughout the day, every 23 hours, to keep the flexibility during this important time of healing. Microsoft word infosheet proximal humerus fracture2 author. The pdf of the article you requested follows this cover page. Associated with an aging population, the incidence of osteoporotic proximal humerus fractures is increasing and is expected to triple over the next three decades.
Proximal humerus fracture book twin cities orthopedics. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Complications may include axillary nerve or axillary artery injury the cause is generally a fall onto the arm or direct trauma to the arm. Increase rom while protecting the fracture site you can be slightly more. Rehabilitation goals protect repair minimize pain and swelling maintain rom of surrounding joints prevent adhesive capsulitis.
Post fracture proximal humerus rehabilitation guidelines. Appointments begin physical therapy at 1 week post op, 2 xweek follow up with md 1014 days post op. There may be a decreased ability to move the arm and the person may present holding their elbow. Humerus fx orif protocol proximal, midshaft, or distal. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. General principles of rehabilitation for fractures treat the patient not the fracture move all joints that are not immobilized prevent disuse atrophy use gravity to assist in mobilizing a joint. Extension and internal rotation not performed until 6 weeks 4. O arm in sling at all times except for exercises and bathing. Use the video or information below to gain a better understanding of your injury and what can be done to maximise your recovery.
This typically happens after a fall on the affected side, followed by pain in that arm or shoulder. Gain adequate strength in the rotator cuff to allow for humeral head depression necessary to avoid impingement strengthen scapular musculature to allow for proper scapulohumeral rhythm intervention. Proximal humerus fractures account for a majority of fractures of the upper arm and 5% of all fractures. The shoulder is a ball and socket joint and you have fractured the ball part. Phase i 0 to 21 days begin elbow, wrist and hand active rom. Antti launonen and team assess surgery compared with locking plate and nonoperative treatment for displaced twopart proximal humerus fractures in a superiority, assessorblinded, randomized trial in six hospitals in finland, estonia, sweden, and denmark. Non displaced 2 part fracture good alignment does not involve an articular surface. Discomfort will be moderate for the first few days and will gradually get better. Maintain range of motion rom without displacing the proximal humerus fracture. Around the world, this type of fracture remains a major challenge for treating surgeons.
Proximal humerus fracture is quite a common injury among elderly population who. Barrington physician offices illinois bone and joint. Begin normal light activities with the arm and shoulder. Wear the sling full time for 2 weeks, and then only wear when outside the home for 4 more weeks.
Bony healing occurs usually within 6 to 8 weeks in adults 2. Return to normal function and motion may require 4 months 6 months. Knowledge of the complex bone and soft tissue anatomy of the shoulder is paramount in successful treatment of proximal humerus fractures. If a fracture or fracture repair is stable, then therapy should be started early. Appointments no pt for 3 weeks, unless otherwise specified by md rehabilitation goals modalities to control pain and swelling protect fracture site maintain rom in surrounding joints prevent deconditioning. The most useful rehabilitation protocol is the threephase system. Interventions for proximal humerus fractures strengthening exercise. Post operative rehabilitation protocol following nondisplaced. Common causes of a proximal humerus fracture include. The incidence of proximal humeral fractures lies between 105 and 342 per 100 000 persons per year. Unstable proximal humerus fracture rehab protocol introduction this protocol is for patients with displaced proximal humerus fractures that dont require surgical repair i. Patients typically start physical therapy after the 4 week. Post fracture proximal humerus rehabilitation guidelines r l humerus fracture. Phase i 0 21 days begin elbow, wrist and hand active rom.
1150 539 440 317 458 433 897 196 1270 1624 333 1054 1564 823 1338 668 1064 1388 1040 828 127 636 1400 1658 991 1547 951 1483 1104 1236 1137 1354 1196 1141 1331 1368 941 1233 1246