Post-Operative Rehabilitation Protocol for Clavicle Fracture with Plate Fixation
Begin immediate mobilization without immobilization after plate fixation of clavicle fractures, as this approach safely accelerates functional recovery without increasing complications. 1
Immediate Post-Operative Period (0-2 Weeks)
Apply cryotherapy immediately postoperatively and continue through the first week to manage pain and inflammation 2. A sling may be used for comfort but is not mandatory for immobilization 1.
- Initiate hourly stretching exercises immediately after surgery rather than enforcing a period of immobilization 1
- Patients can safely begin active range of motion exercises without restriction 1
- This early mobilization protocol results in excellent outcomes without increasing complication rates 1
Early Rehabilitation Phase (2-6 Weeks)
By 4 weeks, discontinue sling use entirely for routine activities, but patients must continue to avoid lifting, pushing, or pulling with the affected arm 2.
- Begin isometric strengthening exercises for shoulder girdle muscles by 4-6 weeks, starting with non-weight-bearing exercises 2
- Expect SANE scores around 73% at 2 weeks and 89% at 6 weeks for acute fractures 1
- Full range of motion typically returns by approximately 17 days post-operatively with this protocol 1
Intermediate Phase (6-12 Weeks)
Combine strength training with neuromuscular control exercises by 6-12 weeks to restore functional capacity 2.
- Radiographic union typically occurs by 9.5 weeks for acute fractures 3
- Full weight-bearing activities are allowed between 8-12 weeks, depending on radiographic evidence of healing and clinical examination 2
- Most patients achieve SANE scores of 96% by 3 months 1
Return to Activity Criteria (12+ Weeks)
Before clearing patients for return to heavy labor or contact sports, confirm:
- Shoulder strength with isokinetic testing showing >90% symmetry compared to the contralateral side 2
- Full range of motion without pain or compensatory patterns 2
- Radiographic evidence of complete union 2
Critical Advantages of Early Mobilization
The immediate motion protocol offers substantial benefits compared to traditional immobilization approaches:
- Faster functional recovery with earlier return to work and sports activities 1
- Excellent patient satisfaction without increased complication rates 1
- Potential healthcare cost-savings by reducing the need for prolonged physical therapy 1
- Superior outcomes compared to nonoperative management, with Constant and DASH scores significantly improved at all time points 4
Common Pitfalls to Avoid
Do not enforce prolonged immobilization - this delays recovery without providing any protective benefit after stable plate fixation 1. The traditional approach of 6 weeks of immobilization is outdated and unnecessarily restrictive.
Monitor for hardware-related complications, as these represent the most common reason for repeat intervention, including local irritation, prominence, or infection 4. However, anterior-inferior plating techniques show minimal incidence of implant prominence problems 3.
Ensure patients understand the difference between early motion and early loading - while immediate range of motion is encouraged, heavy lifting and weight-bearing should be restricted until 8-12 weeks 2.