Early Mobilisation in Proximal Humerus Fractures: Is a Stratified Rehabilitation Protocol Safe?
- Author:
Chua SKK
1
;
Lim CJ
1
;
Wong WSY
2
;
Chua ITH
3
;
Kwek EBK
1
;
Tan BY
1
Author Information
1. Department of Orthopaedic Surgery, Woodlands Hospital, Singapore
2. Department of Occupational Therapy, Allegro Specialist Rehab, Singapore
3. Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
- Publication Type:Journal Article
- Keywords:
proximal humerus fractures;
rehabilitation;
stratified;
nonoperative;
personalised
- From:Malaysian Orthopaedic Journal
2026;20(No. 1):56-
- CountryMalaysia
- Language:English
-
Abstract:
Introduction: There remains little evidence on rehabilitation
protocols for proximal humerus fractures (PHFs), although
early mobilisation has been associated with positive clinical
outcomes. There may be a potential role in allowing patients
with more stable fractures to undergo an accelerated
rehabilitation process to facilitate quicker return to function,
although it must be balanced with safety concerns of
premature mobilisation and logistical concerns of
implementation with excessive stratification. The study aim
was to report the overall safety and outcomes of a simple and
implementable 2-tier stratified rehabilitation protocol based
on fracture stability adopted by our institution for nonoperatively treated PHFs.
Materials and methods: Patients in our institution (level 1
trauma centre) with non-operatively treated PHFs underwent
a stratified rehabilitation protocol that classified patients into
Accelerated versus Standard arms - with more stable
fractures undergoing an accelerated rehabilitation
programme. The Oxford Shoulder Score (OSS), Quick
Disabilities of the Arm, Shoulder and Hand Score
(QuickDASH), EuroQol-5-Dimensions (EQ5D)
questionnaires, shoulder range of motion (ROM) and grip
strength were measured at six months and one year postinjury. The frequency of adverse events requiring surgical
intervention was noted.
Results: We included 164 patients and 43% (71/164) went
through the accelerated protocol. Overall, patients had
favourable OSS (median[range] 47[44-48]), EQ5D (median
[range] 1.0[0.82-1.00]), QuickDASH scores (median[range]
2.3[0- 10.7]), and shoulder ROM and grip strength above the
requirement for functional activities of daily living at 1 year.
There were no adverse events reported 1-year post-injury.
Conclusion: This study was the first to report the safety and
outcomes of a stratified rehabilitation protocol for PHFs. Our
simple 2-tier stratified rehabilitation protocol which allowed
a shorter period of rehabilitation and earlier return to
function for patients with more stable PHFs is
implementable, safe and had overall favourable functional
outcome scores.
- Full text:2026030911004626121proximal-humerus-fractures.pdf
