What is the recommended duration for immobilizing a humeral neck fracture in a sling?

Immobilization Duration for Humeral Neck Fractures

For humeral neck fractures, immobilization in a sling should be limited to 1 week, followed by early mobilization, as this approach results in less pain without compromising outcomes. 1

Recommended Immobilization Protocol

• Initial immobilization period: 1 week in an arm sling
• Early mobilization: Begin after 1 week of immobilization
• Self-directed exercise program: Should be initiated with adequate instruction after the initial immobilization period

Evidence Supporting Early Mobilization

The American Academy of Orthopaedic Surgeons (AAOS) recommends early mobilization at 1 week rather than extended immobilization for several reasons 1:

• Results in less pain
• Does not compromise long-term outcomes
• Arm slings are generally more comfortable than body bandages
• Prevents unnecessary stiffness and loss of function

A study from 1980 found that the duration of initial rest in a sling directly affected outcomes, with early active movements within the limits of pain and discomfort suggested to improve ultimate results 2.

Special Considerations

For Displaced vs. Non-displaced Fractures

• Non-displaced fractures: Early mobilization is particularly beneficial

  • 94% satisfactory results reported with early movement 2
  • Self-directed exercise programs can achieve satisfactory outcomes when patients are given sufficient instruction 1

• Displaced fractures: May require surgical intervention before mobilization protocol

  • If surgical fixation is performed, similar early mobilization principles apply
  • One case report of anatomical neck fracture with posterior dislocation showed good outcomes with 5 weeks of immobilization in a Gilchrist brace after surgical fixation 3

Monitoring During Recovery

• Regular assessment of clinical and radiographic evidence of healing should guide progression to unrestricted activity 1
• Monitor for:
  • Pain levels during movement
  • Range of motion progress
  • Signs of displacement or complications

Common Pitfalls to Avoid

1. Prolonged immobilization: Extended periods beyond 1 week can lead to:

   • Increased stiffness
   • Poorer functional outcomes
   • Longer rehabilitation periods

2. Inadequate patient education: Patients need clear instructions for self-directed exercises to achieve optimal outcomes

3. Failing to individualize based on fracture stability: While early mobilization is generally recommended, the specific protocol may need adjustment based on fracture stability and surgical intervention

Conclusion for Clinical Practice

The evidence strongly supports limiting sling immobilization to 1 week for humeral neck fractures, followed by a progressive, self-directed exercise program. This approach optimizes pain control and functional outcomes while minimizing complications associated with prolonged immobilization.