What is the recommended duration for an elderly patient to wear a sling for a compacted humeral head fracture?

Duration of Sling Immobilization for Elderly Patients with Compacted Humeral Head Fractures

For elderly patients with compacted (impacted) humeral head fractures, the sling should be worn for comfort only and may be discontinued as early as the patient's pain allows, typically within 1-2 weeks, with early mobilization exercises beginning within the first few days. 1

Sling Use Guidelines

The sling is not used for rigid immobilization but rather for comfort and pain relief. 1 The key principle is that the duration is patient-directed based on pain tolerance rather than a fixed time period. 2

• Discontinue the sling as soon as pain permits, which may be as early as a few days to 2 weeks for most patients with stable, impacted fractures 1
• The sling serves primarily to reduce gravitational stress on the shoulder and provide comfort during the acute pain phase 2

Early Mobilization Protocol

Range-of-motion exercises should begin within the first postoperative days (or first few days after injury in non-operative cases), including shoulder, elbow, wrist, and hand motion. 1

Immediate Phase (Days 1-3):

• Start finger and hand motion immediately to prevent edema and stiffness 1
• Begin gentle pendulum exercises and passive range of motion as pain allows 3

Early Phase (Week 1-3):

• Progress to active-assisted range-of-motion exercises for shoulder, elbow, wrist, and hand 1, 3
• Evidence suggests mobilization at one week instead of three weeks alleviates short-term pain without compromising long-term outcomes 4

Activity Restrictions:

• Restrict above-chest level activities until fracture healing is evident (typically 6-8 weeks), regardless of whether treatment is operative or non-operative 1, 3
• Avoid overly aggressive physical therapy, which may increase risk of complications 1

Clinical Context for Compacted Fractures

Most proximal humeral fractures, particularly stable impacted fractures in elderly patients, can be treated non-operatively with good functional outcomes. 1, 5 The PROFHER trial demonstrated no significant difference between surgical and non-surgical treatment for displaced proximal humeral fractures over 2 years. 5

Important Caveats:

• Prolonged immobilization (beyond 3 weeks) increases risk of stiffness and poor functional outcomes in elderly patients 4
• Patients who receive early physiotherapy without prolonged immobilization show better pain relief and potentially better recovery 4
• The elderly population is at particular risk for shoulder stiffness and frozen shoulder if immobilized too long 6

Multidisciplinary Considerations

For elderly patients with fragility fractures:

• Evaluate for osteoporosis and consider calcium/vitamin D supplementation (1000-1200 mg calcium daily, 800 IU vitamin D) 1, 3
• Assess for fall risk and implement fall prevention strategies 1
• Provide adequate pain management to facilitate early mobilization 1, 3