What type of immobilization is recommended for a humerus head fracture?

Immobilization for Humeral Head Fractures

For humeral head fractures, immobilization with a removable splint or sling is recommended for minimally displaced fractures, with early controlled mobilization as soon as pain allows to achieve optimal functional outcomes. 1

Initial Immobilization Options

• First-line immobilization: Removable splint or sling for 1-2 weeks 1
• For posterior stability: A posterior splint may provide better pain relief in the first 2 weeks compared to collar and cuff immobilization 2
• Duration: Typically 1-2 weeks before beginning controlled mobilization 1

Immobilization Based on Fracture Type

1. Minimally displaced fractures:

   • Removable splint or sling
   • Gilchrist sling for 1-2 weeks 3
   • Early functional exercises once fracture stability is confirmed

2. Displaced fractures (>1 cm displacement or >45° angulation):

   • Reduction may be attempted first
   • If reduction is successful and stable: conservative immobilization
   • If unstable or irreducible: surgical intervention may be necessary 3

Rehabilitation Protocol

The three-phase rehabilitation protocol following immobilization 1:

1. Initial phase (0-2 weeks):

   • Sling immobilization
   • Gentle pendulum exercises

2. Early mobilization phase (2-6 weeks):

   • Progressive active-assisted range of motion exercises
   • Removal of posterior splint
   • Initiation of physical therapy

3. Strengthening phase (6-12 weeks):

   • Progressive resistive exercises
   • Scapular stabilization exercises

Monitoring and Follow-up

• Regular radiographic evaluation at 1,3, and 6 weeks to ensure fracture stability 1
• Clinical assessment of pain and range of motion at each follow-up
• Monitor for potential complications:
  • Delayed union or nonunion (risk approximately 7.0%) 4
  • Stiffness due to prolonged immobilization
  • Functional limitations

Important Considerations

• Early mobilization is crucial to prevent stiffness and optimize functional outcomes 1
• Functional exercises should continue beyond bone union (expected at 6-8 weeks) 3
• Elderly patients may require additional bone health evaluation and osteoporosis management 1

Common Pitfalls to Avoid

1. Prolonged immobilization: Can lead to shoulder stiffness and poor functional outcomes
2. Inadequate radiographic follow-up: May miss progressive displacement requiring surgical intervention
3. Insufficient pain control: Can delay initiation of early mobilization exercises
4. Overlooking osteoporosis: Especially in elderly patients, bone quality assessment is important

The evidence shows that even with appropriate conservative management, patients should expect some functional limitations. At one year post-injury, studies show a mean difference in Constant scores of 8.2 points between injured and contralateral shoulders 4.