ORIF proximal humeral fractures

(Proximal Humeral Locking Plate)


On Ward:

  • Sling for 3/52. Can remove sling at night after 3/52 if comfortable.
  • Day 1 on ward – commence active-assisted elevation, external rotation to neutral, short lever abduction and elevation in internal rotation. Can commence active external rotation as pain allows. Exercises may be taught to relative as appropriate.
  • Maintenance elbow, wrist, hand and neck exercises, sling care + washing techniques. v Scapula setting and posture
    N.B. AVOID axial loading for 3/12.
  • Review by clinical specialist at 2/52 post-op in clinical specialist shoulder clinic at RSH, to be booked before discharged by ward staff.

2-6 weeks:

  • 3/52. Active ROM can be commenced in all movement planes ensuring good quality of movement. Hydrotherapy or use of gentle stretches, Grade II accessory movements or soft tissue mobilisations to increase ROM. No forced movements.
  • Commence early static cuff exercises at week 2 and progress light rotator cuff and deltoid strength through range 4-6/52 as able.
  • All 3 and 4 part fractures have had repair of greater and/or lesser tuberosities therefore treat as cuff repair protocol

6 weeks:

  • Clinic review at 6/52, 3/12 and 6/12 and 1 year.
  • If all well, full active exercises as tolerated, may include closed chain and proprioceptive exercises.
    Progress overall strength of rotator cuff and deltiod and concentrate on functional and occupational rehabilitation.

Return to work: Sedentary 4 weeks (as pain allows). Modified Physical 3 months (as guided by surgeon).
Driving: 6 weeks (as pain and range allows) patient confirms safety to drive.
Sport: 3-4 months dependent on activity (as guided by surgeon). Contact sports: Discuss with surgeon
Swimming: Gentle with modified stroke 6 weeks onwards.