Proximal Humerus Fracture — ORIF

Dr. Katherine J. Coyner MD (UConn Musculoskeletal Institute) · Dr. Katherine J. Coyner MD

Weight-Bearing

Sling at all times x 2 wks including nighttime; may D/C at wk 4 if comfortable; inpatient 0-4 days then outpatient

Key Restrictions

No ER >40 deg x 6 wks; no active IR x 6 wks; no cross-body adduction x 6 wks; no lifting/pushing/pulling >5 lbs x 6 wks; no IR behind back until Phase III (wk 8); no anti-inflammatory medications x 6 wks (unless on ASA for other reasons); tuberosities must heal before RTC stress; no ABD Phase I; hydrotherapy OK at wk 3 if wound healed (within ER 40 + no active IR limits)

Timeline & Phases

4 phases: Inpatient (0-4 days, sling; pendulums; PROM FF 90 + ER 30; home program), Phase 1 OP (hospital D/C-wk 4, sling at all times x 2 wks; PROM FF 90 + ER 30; scapular retraction; postural correction), Phase 2 (wks 4-8, sling D/C if comfortable; self-assisted FF 90 + 20 deg increments/wk; ER 40; grade I-II mobs; no cuff strengthening; hydrotherapy wk 3+ within ROM limits), Phase 3 (wks 8-12, progressive full FF and ER; IR behind back begins; grade III-IV mobs; posterior capsule + pec minor stretching; submaximal isometric RTC; manual resistance scapular), Phase 4 (wks 12+, progressive isotonic RTC; functional activities)

Notes

UConn academic medical center protocol; notable precaution: no NSAIDs x 6 wks (fracture healing concern); inpatient phase explicitly described (0-4 days); no active IR x 6 wks; hydrotherapy permitted at wk 3; IR behind back explicitly starts Phase 3 (wk 8); FF progresses 20 deg/wk from 90 deg starting wk 4; pec minor and posterior capsule stretching Phase 3

Surgeon / Author

Dr. Katherine J. Coyner MD