Post-Operative Management After Clavicle ORIF
Begin immediate mobilization with early range of motion exercises within the first postoperative week, avoiding immobilization beyond simple sling use for comfort, as this approach safely accelerates functional recovery without increasing complications. 1, 2
Immediate Post-Operative Period (0-2 Weeks)
Immobilization
- Use a simple sling for comfort only, not for strict immobilization 1
- The American Academy of Orthopaedic Surgeons recommends a sling as the preferred method over figure-of-eight bracing 1
- No rigid immobilization is necessary after stable plate fixation 2
Early Mobilization Protocol
- Begin hourly gentle stretching exercises immediately postoperatively 2
- Initiate passive and active-assisted range of motion within the first week 2
- Apply cryotherapy during the first postoperative week to reduce pain and swelling 3
- Patients can safely begin early motion without increasing complication rates 2
Activity Restrictions
- Avoid lifting, pushing, or pulling with the affected arm 1
- Discontinue sling use for routine activities as tolerated, typically by 2-4 weeks 1
Weeks 2-6: Progressive Strengthening
Physical Therapy Initiation
- Formal physical therapy should begin within the first 2 weeks postoperatively 2, 4
- Focus on restoring full range of motion, which typically occurs by 17 days in acute cases 2
- Progress from passive to active-assisted to active range of motion exercises 2
Common Pitfall
- Adhesive capsulitis or stiffness develops in approximately 20% of patients who do not engage in early, aggressive physical therapy 4
- This complication is preventable with immediate mobilization protocols 2, 4
Functional Milestones
- SANE (Single Assessment Numeric Evaluation) scores reach approximately 73% by 2 weeks and 89% by 6 weeks with early mobilization 2
- Full shoulder range of motion is typically achieved by 2-3 weeks 2
Weeks 6-12: Advanced Strengthening
Progressive Loading
- By 4 weeks, most patients discontinue sling use entirely for routine activities 1
- Continue avoiding heavy lifting, pushing, or pulling until 8-12 weeks 1
- Introduce closed kinetic chain exercises (wall push-ups, weight shifts) before progressing to open chain movements 3
Strengthening Protocol
- Progress to resistance exercises as tolerated based on pain and clinical examination 2
- Include muscle strengthening exercises with long-term continuation 1
- Monitor for signs of complications requiring medical attention 1
Return to Full Activity (3-6 Months)
Weight-Bearing and Heavy Activities
- Full weight-bearing activities are typically allowed between 8-12 weeks, depending on radiographic evidence of healing 1
- Return to work occurs at a mean of approximately 3 months, with acute cases returning faster than nonunion cases 2
- Return to heavy sports and activities is generally safe by 3-6 months 2
Functional Outcomes
- SANE scores reach 96% by 3 months with early mobilization protocols 2
- All patients in prospective studies returned to full shoulder range of motion and heavy activities 2
- Functional outcomes are excellent (DASH scores 98-100) in approximately 82% of patients by 6 months 4
Key Evidence Supporting Early Mobilization
The most compelling evidence comes from a 2017 prospective case-control study demonstrating that immediate motion protocols following plate fixation result in excellent functional outcomes without increasing complication rates 2. This study showed:
- Only 1 transient frozen shoulder in 42 patients with immediate mobilization 2
- Significantly faster return of function compared to delayed mobilization 2
- No increase in surgical complications with early motion 2
Critical Warnings
High-Risk Patients
- Smokers, obese patients, and those with transverse or Z-type fractures have significantly higher complication rates (up to 27% overall, 9% requiring reoperation) 5
- These patients require closer monitoring during rehabilitation 5
- Smoking increases nonunion rates and leads to inferior clinical outcomes 1