Patient discussions
Following nonoperative management
A broad arm sling is used for comfort and protection and use can be discontinued as pain allows. Advise patients (especially older adults) to avoid prolonged immobilization of more than 1-2 weeks, in order to decrease the risk of significant atrophy, adhesive capsulitis, or arthrofibrosis.[86]
Advise gentle, pain-free range of motion exercises for the fingers, wrist, and elbow for a few minutes 2-3 times daily, even while a sling is being used. Reassure the patient that there is no harm in taking their hand out of the sling. Encourage the patient to try to bring their hand to their mouth for feeding and hygiene, as this will encourage movement of the elbow, wrist, and hand, as well as expedite function.
Discuss with the patient the possibility of a formal physical therapy regimen versus a home-based program, as required.
Ice may be used to help alleviate pain and swelling in the first 1-2 weeks after the injury. Advise careful use for 15-20 minutes at a time, with at least 1 hour between sessions and avoid placing ice directly on the skin.
Analgesics (such as acetaminophen and/or nonsteroidal anti-inflamatory drugs [NSAIDS] or, for high-energy trauma, an opiate) may be helpful for controlling pain. Advise the patient to try to discontinue use of analgesia within 1-2 weeks if possible so as to decrease the risk of adverse medication effects.
Begin shoulder range of motion exercises at 2-3 weeks after injury. Begin with pendulum exercises then increase motion as tolerated.
The patient should avoid heavy lifting and any painful movements or activities in the immediate post-injury period and for at least 6-8 weeks to allow for fracture healing. The patient may gradually resume more strenuous activities as tolerated, beginning 8 weeks after injury.
Following operative management
Use a sling for postoperative comfort and protection, and discontinue as pain allows. Patients should return to the fracture clinic 2 weeks after surgery to check incisional healing. Begin shoulder range of motion exercises at about 2 weeks after surgery. Start with pendulum exercises, then increase motion as tolerated.
Return for orthopedic evaluation at 6 weeks after surgery for a wound check and x-ray evaluation to assess for fracture healing and alignment. If the incision is healing well and x-ray is unremarkable, follow up as needed, and the patient may gradually return to normal activities over the course of 4-5 months postoperatively.
Use of this content is subject to our disclaimer