Duration of Arm Immobilization for Non-Displaced Proximal Humerus Fractures in Children
For a child with a non-displaced proximal humerus fracture, immobilize the arm in a posterior splint for 3 weeks, followed by initiation of passive range-of-motion exercises.
Immobilization Method and Duration
Use a posterior splint (back-slab) rather than a collar and cuff for initial immobilization. The AAOS guidelines, based on two moderate-quality prospective studies, demonstrate that posterior splint immobilization provides superior pain relief within the first 2 weeks compared to collar and cuff immobilization for nondisplaced pediatric supracondylar and proximal humeral fractures 1.
Standard Immobilization Protocol
- Immobilize for 3 weeks in a posterior splint or shoulder-arm sling 2
- The splint should maintain the arm in a protected position during this healing phase 2
- This duration allows adequate early fracture healing while minimizing stiffness risk 2
Post-Immobilization Rehabilitation
Phase 2: Weeks 3-6
- Begin pendular and active-assisted exercises at 3 weeks after injury 2
- This gradual progression prevents stiffness while protecting the healing fracture 2
Phase 3: After 6 Weeks
- Initiate active exercises starting at 6 weeks post-injury 2
- Full recovery typically requires an average of 8 months, though functional improvement occurs progressively 2
Critical Monitoring Requirements
Obtain radiographic follow-up during the first 3 weeks of treatment and at cessation of immobilization to confirm the fracture remains non-displaced 3. This is essential because any displacement would require treatment modification.
Important Clinical Caveats
- Set realistic expectations: Patients and families should understand that while outcomes are favorable with this protocol, full recovery from pain and restoration of complete range of motion averages 8.1 months (range 1-24 months) 2
- The AAOS guidelines acknowledge insufficient evidence to definitively recommend optimal immobilization duration for all pediatric proximal humerus fractures 1, but the 3-week protocol represents standard practice supported by clinical outcomes data 2
- Avoid prolonged immobilization beyond 3-4 weeks as this increases stiffness risk without improving fracture healing 4