Postoperative treatment of proximal humerus fractures with an early active motion protocol: a prospective randomized...

Proximal humerus fractures are common injuries in elderly patients. Although a majority of fractures can be treated conservatively, open reduction and internal fixation (ORIF) with locking plates is still the most commonly used operative treatment modality. Regarding postoperative treatment, there is currently no consensus in the literature. A restrictive rehabilitation regimen, which can lead to a prolonged and effortful rehabilitation process, may not make full use of the possibilities that modern angular stable implants in combination with adequate patient selection and improved operative techniques have to offer. Therefore, this study aimed to investigate the functional results of a novel early active motion rehabilitation protocol for postoperative treatment of proximal humerus fractures treated with a locking plate.

From March 1, 2016, to February 29, 2023, patients were prospectively screened for inclusion. In the conventional group (CG), patients underwent a strict postoperative protocol with immobilization in a shoulder-arm sling for 4 weeks, which should be worn day and night. In the early functional group (EFG), no restrictions regarding movement and force were given. In both groups, no heavy lifting, no exhausting physical activity, and no blunt force on the arm was performed for 3 months postoperatively. Within a follow-up of 24 months, primary and secondary outcome parameters were collected.

No significant difference was found in the Disabilities of the Arm, Shoulder and Hand (DASH) score, Constant score (CS), and relative CS for the injured shoulder at any point of observation. After 24 months, the CS showed a mean of 81.3 (standard deviation [SD] 11.6) points in the CG and 78.4 (SD 14.0) points in the EFG. Relative CS was 89.8% of the uninjured side in both groups, respectively. DASH score showed a mean of 15.9 (SD 15.8) in the CG and 13.9 (SD 15.2) in the EFG. There was also no significant difference in visual analog pain scale score, patient satisfaction, and EuroQol-5 Dimensions visual analog scale score in between the groups.

It could be demonstrated that early active motion rehabilitation for postoperative treatment after locking plate fixation of proximal humerus fractures was not inferior to a restrictive treatment protocol after a follow-up period of 24 months, even in a slightly older and more comorbid patient population. Further studies investigating postoperative rehabilitation after ORIF of proximal humerus fractures should be conducted.