CURRENT CONCEPTS IN ADULTS UPPER EXTREMITY FRACTURES

21452Ugur_TiftikciCurrent_Consept_in_adults.kapak

REHABILITATION PROTOCOLS FOR ARM FRACTURES

Mehmet Fırat Tantekin

Diyarbakır Selahaddin Eyyubi State Hospital, Department of Orthopedics and Traumatology, Diyarbakır, Türkiye

Tantekin MF. Rehabilitation Protocols for Arm Fractures. In: Tiftikçi U, Erdoğan E, Ergün C, Güneş Z, editors. Current Concepts in Adults Upper Extremity FractureS. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.339-345.

ABSTRACT

The majority of humerus fractures can be managed without requiring surgical intervention. In younger individuals, these fractures are often the result of high-energy trauma and are typically not categorized as minimally displaced. In older adults, however, humerus fractures usually occur due to low-energy trauma. The treatment protocol depends on various factors, such as the patient’s overall condition, bone quality, and the surgeon’s experience. The purpose of this section is to design a treatment protocol that allows for early rehabilitation in both conservatively treated and surgically managed fractures. In proximal humerus fractures, rehabilitation should begin early to improve shoulder mobility and reduce distal edema. Numerous studies have shown that early mobilization reduces pain, improves movement, and enhances the functional use of the affected limb.

The primary strategy focuses on aligning the fracture fragments to allow them to move in unison, a process that generally occurs within 1 to 4 weeks. Healing is confirmed through the appearance of callus formation on X-rays, which can be observed as early as 6 weeks. Nonetheless, more intensive movements should be avoided until full healing has been accomplished. In conservative treatment, a sling is typically used for proximal stabilization for 4 to 6 weeks. Pain management should be initiated appropriately, and frequent ice application at home may be recommended. The rehabilitation process for surgically treated proximal humerus fractures follows the same guidelines as non-surgical treatment but may progress more quickly due to the stabilization achieved by surgery.

In humerus shaft fractures, the primary goal of treatment is to preserve bone integrity, promote union, and restore the normal range of motion in the shoulder and elbow. In conservative treatment, stabilization is achieved using a custom-made or prefabricated fracture brace, along with a neck collar and arm sling. Clinical improvement is generally seen within 3 to 4 weeks. After the 4th week, isometric strengthening exercises for the supination and pronation muscles should also be initiated. Under the therapist’s guidance, with the shoulder supported in approximately 90 degrees of flexion, gentle active scapular protraction and retraction exercises should be initiated in the supine position. After the 6th week, shoulder extension and light internal rotation exercises should be initiated, progressing to shoulder abduction based on pain tolerance. In surgical treatment, after the fracture has been stabilized, the treatment process typically follows a nonoperative protocol. However, certain therapeutic needs may vary depending on the specific surgical procedure performed.

Keywords: Humerus; Shoulder; Elbow; Rehabilitation; Humeral Fractures

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