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The following is a summary of “Postoperative Treatment of Proximal Humerus Fractures with an Early Active Motion Protocol – A Prospective Randomized Controlled Trail,” published in the March 2025 issue of the Journal of Shoulder and Elbow Surgery by Crepaz-Eger et al.

Proximal humerus fractures are among the most frequently encountered orthopedic injuries in older patients. While conservative treatment remains the preferred approach for most cases, open reduction and internal fixation (ORIF) using locking plates continues to be the standard operative intervention when surgical management is required. However, there is no established consensus regarding the optimal postoperative rehabilitation strategy. 

Conventional restrictive rehabilitation protocols, which often involve prolonged immobilization, may hinder recovery by failing to capitalize on advancements in angular stable implants, improved surgical techniques, and refined patient selection criteria. This study aimed to evaluate the functional outcomes of a novel early active motion rehabilitation protocol following ORIF with a locking plate for proximal humerus fractures.

Between March 1, 2016, and February 29, 2023, patients were prospectively screened for inclusion. Participants were assigned to one of two rehabilitation protocols. The conventional group (CG) followed a strict postoperative regimen requiring immobilization with a shoulder-arm sling worn continuously for four weeks. The early functional group (EFG), in contrast, had no restrictions on movement or force application. In both groups, patients were advised to avoid heavy lifting, exhaustive physical activity, and blunt force trauma to the affected arm for a period of three months. Primary and secondary outcome measures were assessed over a follow-up period of 24 months.

Results demonstrated no significant differences between the two groups in functional recovery as measured by the Disabilities of the Arm, Shoulder and Hand (DASH) Score, the Constant Score, and the relative Constant Score of the injured shoulder at any time point. At 24 months postoperatively, the Constant Score averaged 81.3 points (SD 11.6) in the CG and 77.6 points (SD 14) in the EFG. The relative Constant Score was 89.8% of the uninjured side in both groups. The mean DASH score was 15.9 (SD 15.8) in the CG and 13.8 (SD 14.8) in the EFG. Additionally, no significant differences were observed in Visual Analog Scale (VAS) scores for pain, patient satisfaction, or EQ-5D scores between the two rehabilitation protocols.

In conclusion, their findings suggest that early active motion rehabilitation following locking plate fixation of proximal humerus fractures is not inferior to a restrictive rehabilitation protocol, even in an older patient population with greater comorbidities. These results indicate that early mobilization may be a viable alternative to traditional restrictive approaches without compromising functional outcomes. Further studies are warranted to refine postoperative rehabilitation strategies and optimize recovery in patients undergoing ORIF for proximal humerus fractures.

Source: jshoulderelbow.org/article/S1058-2746(25)00186-7/abstract