Proximal humerus fracture rehabilitation

Area of Science:

• Orthopedics
• Geriatric Medicine
• Physical Therapy

Background:

• Proximal humerus fractures are increasing in the elderly population.
• Osteoporosis and poor neuromuscular control in these patients increase fall risk and re-fracture rates.
• Long-term shoulder problems are common after these injuries.

Purpose of the Study:

• To review the literature on optimal rehabilitation strategies for proximal humerus fractures.
• To identify effective interventions for restoring upper limb function and optimizing bone healing.
• To challenge traditional prolonged immobilization protocols.

Main Methods:

• Systematic review of level II diagnostic studies.
• Analysis of evidence regarding electrotherapy, hydrotherapy, joint mobilization, and early mobilization.
• Evaluation of current UK treatment protocols.

Main Results:

• Immediate rehabilitation is crucial to avoid negative effects of immobilization.
• Electrotherapy and hydrotherapy show no benefit in recovery.
• Joint mobilization has limited evidence; early, controlled stress on the fracture site optimizes bone repair.
• Current UK practice of prolonged immobilization (3+ weeks) is not supported by best evidence.

Conclusions:

• The best evidence supports early advice, exercise, and limited joint mobilization for proximal humerus fracture rehabilitation.
• Controlled early stress optimizes bone healing and minimizes complications.
• Close collaboration between surgeons and therapists is essential for optimal patient outcomes and functional independence.