Physical Restrictions After Surgical Repair of Humerus Fracture
For adult proximal humerus fractures treated with locking plate fixation, immediate unrestricted active motion without immobilization is safe and produces equivalent functional outcomes to restrictive protocols, while for pediatric supracondylar fractures, evidence-based restrictions remain undefined by current guidelines.
Adult Proximal Humerus Fractures (Locking Plate Fixation)
Immediate Postoperative Period
Early active motion protocols without restrictions are non-inferior to traditional immobilization. A 2025 randomized controlled trial demonstrated that patients allowed unrestricted movement immediately after surgery achieved equivalent functional outcomes (Constant Score 77.6 vs 81.3, relative Constant Score 89.8% bilaterally) compared to those immobilized for 4 weeks 1.
Key restrictions that apply to BOTH approaches:
- No heavy lifting for 3 months postoperatively 1
- No exhausting physical activity for 3 months 1
- No blunt force trauma to the operative arm for 3 months 1
Traditional Restrictive Protocol (If Chosen)
If surgeons prefer a conservative approach:
- Shoulder-arm sling immobilization for 4 weeks, worn day and night 1
- Passive range of motion typically begins between 2-6 weeks for 2-part fractures 2
- Weight-bearing restrictions vary by surgeon preference: 19-45% allow immediate weight-bearing after arthroplasty, while 62-75% allow it after ORIF 2
Rehabilitation Approach
Virtual reality-based rehabilitation combined with conventional physical therapy produces superior outcomes. Patients receiving VR-guided therapy plus conventional treatment showed significantly greater improvements in shoulder ROM (flexion t=7.58, P=0.0001; abduction t=9.57, P=0.0001), muscle strength (MMT t=13.86, P=0.0001), and functional scores (DASH t=57.48, P=0.0001) compared to conventional therapy alone 3.
Pediatric Proximal Humerus Fractures
Non-Displaced Fractures
Use posterior splint immobilization for approximately 3 weeks. The American Academy of Orthopaedic Surgeons recommends posterior splinting over collar-and-cuff immobilization because it provides superior pain relief within the first 2 weeks 4.
Mandatory radiographic monitoring:
- Obtain follow-up radiographs during the first 3 weeks of treatment 4
- Repeat imaging at cessation of immobilization to confirm the fracture remains non-displaced 4
Special Case: Little League Shoulder (Overuse Injuries)
Complete throwing cessation for minimum 6 weeks is required. The American Medical Society for Sports Medicine recommends:
- Total 3 months rest from throwing activities 4
- First 6 weeks: complete throwing cessation 4
- Next 6 weeks: strengthening exercises only 4
- Implement rotator cuff, periscapular, and core strengthening with capsular flexibility exercises 4
Pediatric Supracondylar Fractures
Critical Evidence Gap
The American Academy of Orthopaedic Surgeons explicitly states inability to recommend:
- Optimal time for pin removal and mobilization 5
- Whether routine supervised physical or occupational therapy is necessary 5
- Optimal timing for allowing unrestricted activity after healing 5
- Optimal timing or indication for rehabilitation 5
This represents a significant knowledge gap where clinical judgment must guide decision-making, as no studies meeting guideline selection criteria addressed these questions 5.
Common Pitfalls to Avoid
Nonunion risk increases with overly restrictive immobilization. Prolonged immobilization may cause elbow stiffness in pediatric cases, while premature mobilization risks redisplacement or refracture 5. The 3-month restriction on heavy lifting and exhausting activity in adults balances these competing risks 1.
Nerve injury complications occur in 1.1-10% of cases. Monitor for nerve deficits throughout the rehabilitation period, as these can result from both initial trauma and surgical treatment 6. The AAOS guidelines acknowledge insufficient evidence for timing of electrodiagnostic studies or nerve exploration 5.
Surgeon specialty significantly influences rehabilitation protocols. Trauma surgeons typically begin passive ROM earlier (<2 weeks for 70% vs 41% of shoulder surgeons) and allow weight-bearing sooner, while shoulder surgeons prefer more conservative 2-6 week delays 2. Neither approach has proven superiority, but awareness of this variation is important for patient counseling.