Evaluation by randomisation trial a pragmatic multicentre randomised controlled trial evaluating the clinical effectiveness and costeffectiveness of surgical compared with nonsurgical treatment for proximal fracture of the humerus in adults. Type iii is a fracture through the growth plate and the epiphysis. The long bone of the upper arm is known as the humerus. Click on the white play button below to start video hip fractures are most commonly caused by falls. A distal humerus fracture occurs when there is a break anywhere within the distal region lower end of the humerus. Nondisplaced proximal or distal phalanx fracture a. Return to normal function and motion may require 3 to 4 months overall goals. Aug 16, 2019 after distal humerus fracture fixation, the proximal ulna can be reattached by using standard arbeitsgemeinschaft fur osteosynthesefragen aoassociation for the study of internal fixation asif tension band wire technique and either two parallel 0. Subungal hematoma should be decompressed if present via nail puncture or nail avulsion. Pediatric population predisposed, especially during ages when the. Humerus fracture physical therapy, occupational therapy. Surgical treatment of this fracture is used to reduce morbidity, together with postoperative physical therapy.
It is very important to complete physical therapy, and to do the prescribed home exercises in order to get as much motion back as possible. Depends on the type of pelvic fracture and treatment required. Physical therapy in the postoperative of proximal femur. The line of fracture can occur at all levels of the proximal humerus. The distal humerus includes the lateral capitellum, the medial trochlea, the posterior olecranon fossa, and anterior coronoid fossa. Physiotherapy protocol for the profher trial the profher. Humerus fracture physical therapy, occupational therapy, rehab. The elbow complex consists of the distal humerus and proximal ulna and. The elbow complex consists of the distal humerus and proximal ulna and radius forming the humeroulna, humeroradial, and proximal radioulnar joints. The patient is to begin active and passive range of motion of the fingers to prevent stiffness and reduce swelling. May 29, 2018 a distal humerus fracture is a break or crack that involves the distal region of the humerus, which forms the upper part of the elbow joint and lower portion of the arm it is usually caused by a highenergy impact that results from an athletic sport, motor vehicle accident, or a fall on the elbow.
This can be prevented by the early initiation of a rehabilitation program. Efficacy of physiotherapistsupervised rehabilitation after proximal humerus fracture the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Children are more likely to suffer this type of injury. Fractures of the proximal humerus most commonly occur with falls onto an outstretched hand or directly onto the shoulder.
Listing a study does not mean it has been evaluated by the u. A sling and swath, or velpeau with an axillary pad should be used when not doing physical therapy. Doctors give unbiased, trusted information on the use of physical therapy for humerus fracture. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and. Anytime you have a severe injury such as trimalleolar ankle fracture, physical therapy is a great modality to get you back to some what normal stage. A fracture in this area can be very painful and make elbow motion difficult or impossible. Fracturing the bone of your upper armmedically known as a humerus fracturecan be a painful and frightening experience, especially because the most common cause of this type of fracture is a bad fall. The eventual recovery with this treatment is usually very good. Proximal humerus fractures pediatric orthopaedic society. Rehabilitation is central to addressing the problems caused by the fracture. Continue all exercises in previous phase as described above passive and active assisted rom exercises in all planes of shoulder motion, as tolerated. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions.
This prospective randomized study is aim to assess the function of the upper extremity of patients who will be assigned to nonoperative treatment of a proximal humeral fracture. Distal humeral fracture an overview sciencedirect topics. This is rare and when it does occur, it is usually at the distal end of the tibia. Some distal humerus fractures can be treated without an operation, but this is rare. Sean griffin weeks 14 wear the sling full time for 2 weeks, and then only wear when outside the home for 4 more weeks.
Gain adequate strength in the rotator cuff to allow for humeral head depression necessary to avoid impingement strengthen scapular musculature to allow for proper scapulohumeral rhythm intervention. A 63yearold female recreational tennis player presented to physical therapy, progressing well following a proximal humeral fracture, sustained 18 weeks prior. Physical therapy will work first to restore good range of motion, and progress to active exercises and strengthening as the fracture heals. Distal humerus fracture open reduction and internal fixation. Sometimes more involved therapy for range of motion, balance, and strengthening is recommended. Rehabilitation guidelines for proximal humerus fracture nonoperative 2 p a g e phase ii continued precautions dc sling x 3 weeks if cleared by md aarom to 90 degrees forward flexion and 40 degrees er suggested therapeutic exercises arom cervical, elbow, wrist and hand pendelums gripping exercises scapular pnf progress to full. The advent of modern operative fixation techniques has led to an. Nonoperative treatment of proximal humerus fracture rehabilitation considerations o usually nonoperative care is selected for those patients o thopae ic institute of ohio samir patel, who are medically unfit for surgery or have a minimally to nondisplaced fracture o depending on the severity of the fracture the best outcome may. Proximal humerus fracture reverse shoulder arthroplasty. Proximal humeral fracture protocol jay carson, md rehabilitation of the proximal humeral fractures is essential because adequate motion is needed for optimum function. Heal a humerus fracture without surgery the jackson. Physical therapy can be used to expedite return to function when appropriate.
It is a relatively uncommon injury in adults, accounting for only about 2% of fractures. If a fracture or fracture repair is stable, then therapy should be started early. Shoulder functional outcomes of patients with proximal. Electrotherapy or hydrotherapy does not enhance recovery. Fractures of the distal humerus are challenging injuries to treat. Proximal humerus fracture book twin cities orthopedics. Doctors give unbiased, helpful information on indications, contraindications, benefits, and complications. Pdf midshaft humeral fracture following a proximal humeral. A distal humerus fracture dhf is a fracture whose epicenter falls within the square. The following standards of care and protocols are the property of bwh and should not be copied or otherwise. Depending on the location and severity of the fracture, some bones may heal without surgery. Proximal humeral fracture twin boro physical therapy. Key features material represents the best practices of experts with the hospital of special surgery, one of the best known and most respected orthopedic hospitals. Whether or not your fracture requires surgery will then be determined.
The proximal humeral physis contributes approximately 80% of the growth of the humerus. Evidence based postoperative treatment of distal radius. Unfortunately you may not return to 100% of your old level of activities, but. A proximal humeral fracture is a type of injury that results near the shoulder joint.
Physical therapy standards of care brigham and womens hospital. Technical objectives for fixation of distal humerus fractures every screw should pass through a plate every screw should engage a fragment on the opposite side that is also fixed to a plate as many screws as possible should be placed in the distal fragments each screw should be as long as possible. Technical objectives for fixation of distal humerus fractures. The humerus joins with the shoulder blade to form the shoulder joint and the bones of the forearm radius and ulna to form the elbow figure 1. Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. Panagos on physical therapy after humerus fracture. Physiotherapeutic interventions and rehabilitation regimen of. This protocol is based on maintaining range of movement in the first phase and then gradually building strength in the middle to the last phase. Fracture of the clavicle or collar bone clavicular fracture fracture of the humerus or upper arm humeral fracture little league shoulder is a fracture of the proximal shoulder at the growth plate, usually from over head throwing. A myriad of nonsurgical and surgical treatment options exist for these injuries, including shortterm immobilization and early physical therapy, percutaneous fixation, plate osteosynthesis, intramedullary nailing, hemiarthroplasty, and reverse shoulder arthroplasty. Gentle passivesupine shoulder motion, begin with fe and abd, limit erir to 30 degrees. Proximal humeral fracture postsurgical rehabilitation protocol open reduction internal fixation general principles. Physical therapy for distal radius fracture healthtap.
Arthroplasty for treatment of distal humerus fractures. Each type of shoulder fracture has unique characteristics. Functional therapy with short immobilization, followed by an accelerated physiotherapy protocol, is a simple, convenient, noninvasive, and efficient management option. Athletes who use their hands are at high risk for breaking this long, thin bone but this fracture commonly occurs when a person punches a hard object. It may seem like a severe enough break to require surgery, but, in reality, most humerus fractures can be treated by nonsurgical means. The most useful rehabilitation protocol is the threephase system. In evaluating humerus injuries, being able to classify the fracture and if necessary, reduce, immobilize, and know when to seek orthopedic consultation is important. A fracture of your arm bone near the shoulder may require physical therapy to help improve normal arm function. Patient may be in a removable boot after surgery for a week or two at the direction of the physician. The majority of supracondylar humeral fractures are extensiontype fractures 9799% resulting from a fall on. Twopart fractures of the articular surface and 4part fractures have a high incidence of avascular necrosis of the humeral head.
Distal humerus fractures of the elbow orthoinfo aaos. Hip fracture orif physical therapy patient education. Distal upper extremity fractures case type diagnosis. As such, there is extensive remodeling potential in fractures in younger, skeletally immature patients. Type ii extends through the metaphysis and the growth plate. Fractures of the distal humerus elbow result from a fall on the elbow with the. Metacarpal fracture reduction and pinning therapy protocol. Abstract the occurrence of proximal humerus fractures will continue to rise with the increasing elderly population. The following exercises are commonly prescribed to patients with a supracondylar fracture. Pdf midshaft humeral fracture following a proximal. Fixation of proximal humerus, clavicle, scapula and glenoid fractures. Fractures are classified as either an extension or flexiontype fracture. Proximal reffers to being close to the body and humeral refers to the arm bone known as the humerus. Post fracture proximal humerus rehabilitation guidelines.
Nonsurgical treatment may be recommended for stable fractures in which the pieces of bone are not out of place displaced. I have seen a few surgeons send proximal humerus fractures to therapy within the first week, but the pain levels and guarding did not warrant any rom treatment, in my opinion. They are rare injuries and frequently involve the joint. Fractures of the distal humerus in the adult comprise 2 % of all fractures and approximately 30 % of all humeral fractures, with an incidence of 5. A humeral fracture is a condition characterized by a break in the upper arm bone humerus figure 1. Also avoid rotational stresses that may occur with erir of the shoulder, as the torque may not be tolerated through the fracture site. Fractures joint replacement sports medicine humerus fx orif protocol proximal, midshaft, or distal orif dr. Sleep with arm out of sling, straight on pillows with arm elevated for edema reduction. There is a case for specialist assessments, likely by physiotherapist, with. This will help provide pain relief and allow the fracture to heal in a.
Physical therapy interventions may be necessary because this injury tends to stiffen quickly over the first two to three weeks postinjury. Fifth metatarsal fracture jones fracture rehab protocol patient will be walking with crutches nonweightbearing until most of the swelling resolves. Humerus fx orif protocol proximal, midshaft, or distal. Increase rom while protecting the fracture site you can be slightly more. Postsurgical rehabilitation guidelines for the orthopedic. Physiotherapeutic interventions and rehabilitation regimen. Distal humerus fracture a distal humerus fracture is the term used to describe a type of elbow fracture where the lower end of the upper arm bone humerus has been broken. Most of these fractures are treated with a collar and cuff sling followed by physiotherapy. Proximal reffers to being close to the body and humeral refers to. Efficacy of physiotherapistsupervised rehabilitation.
Phase i 0 to 21 days begin elbow, wrist and hand active rom. At the least, therapy for gait training is usually recommended. Nonsurgical management is appropriate for the majority of young children with proximal humeral fractures. Examples include hand therapy procedures, working with postsurgical patients with cerebral palsy, sports patient injuries, and pediatric procedures for disorders such as torticollis. The bone can crack just slightly or break into many pieces comminuted fracture.
Efficacy of physiotherapistsupervised rehabilitation after. Fifth metatarsal fracture jones fracture rehab protocol. The most common complication of proximal humerus fracture is adhesive capsulitis. The broken pieces of bone may line up straight or may be far out of. A proximal humeral upper arm bone fracture is a break in the upper aspect of the humerus, close to the ball and socket glenohumeral joint of the shoulder. Various common injuries in the shoulder, humerus, and elbow are investigated in this section. Bony healing occurs usually within 6 to 8 weeks in adults 2. Unfortunately you may not return to 100% of your old level of. Many patients with proximal humerus fractures have osteoporosis and have poor neuromuscular control mechanisms. Distal radius fracture orif rehabilitation protocol. The proximal femoral fracture in the elderly is a serious public health problem. Salterharris fractures are often the result of sports related injuries however they have also been attributed to child abuse, genetics, injury from extreme cold, radiation and medications, neurological disorders, and metabolic diseases which all affect the growth plate according to the national institute of arthritis and musculoskeletal and. Maintain rom without displacing the proximal humerus fracture.
Therapy services patient information fractured distal radius. Fashion removable longarm splint holding the elbow in 90 degrees of. This is when the proximal humerus is broken into three pieces, and there are then two fracture lines on xray. Physical therapy after humerus fracture answers on healthtap. A distal humerus fracture is a break or crack that involves the distal region of the humerus, which forms the upper part of the elbow joint and lower portion of the arm it is usually caused by a highenergy impact that results from an athletic sport, motor vehicle accident, or a. Humerus fracture broken upper arm physical therapy library. Older adults, especially those over the age of 85, are at the highest risk because of changes in bone structure and overall health. Although the evolution in fracture treatment with fixed angle locking plate falp systems has generally led to therapy regimens that allow fracture healing during the course of early mobilization, the necessity of additional postoperative casting after internal plate fixations in drf is still highly controversial 37, 39, 49, 50. Orif early management of distal radius fractures with orif rehabilitation. Galland on physical therapy for distal radius fracture. Heal a humerus fracture without surgery the jackson clinics. Due to variable stability of the fracture, check for specifications and precautions ordered by the orthopedist. Pediatric population predisposed, especially during ages when the supracondylar bone is undergoing skeletal maturation and has a thin and weak cortex.
This standard applies to patients who have sustained upper extremity fractures that require stabilization either surgically or nonsurgically. This is the most common of the salterharris fractures. A distal humerus fracture is a break in the lower end of the upper arm bone humerus, one of the three bones that come together to form the elbow joint. Distal humerus fracture arm fracture treatment options. A surgical neck fracture happens when the humerus is forced in one direction, and the joint capsule and rotator cuff muscles remain intact.
Physiotherapy protocol for the profher trial the profher proximal fracture of the humerus. Distal humerus orif fracture early motion therapy protocol. A fracture of the 5th metacarpal bone usually occurs from hitting a hard object with a closed fist, according to the 5th metacarpal fracture website, earning the nickname the boxers fracture. The humerus is most frequently fractured as the result of a fall or motor vehicle crash.