Conservative and postoperative care of proximal humeral fractures regarding permissive weight bearing: A survey among surgeons in the Netherlands

Abstract text (incl. references and figure legends)

Background

Proximal humeral fractures (PHF) are common and mostly caused by low-energy injuries in the elderly population. Adequate rehabilitation is essential when it comes to regaining function, regardless of whether it is treated conservatively or operatively. Permissive weight bearing (PWB) is a relatively new rehabilitation concept, characterized by earlier mobilization of the affected limb/joint after trauma. Despite the fact that there are multiple studies investigating the effect of PWB for the lower extremities, this trend, however promising, has not been translated to comparable trauma in the upper extremity i.e PHF. Our aim was to investigate the current state and variability of rehabilitation of PHF and the role of implementing PWB in the aftercare.

Methods

An online survey, comprising of 23 questions, was distributed amongst Dutch orthopaedic- and trauma surgeons via the Dutch Orthopaedic and Dutch Trauma Society newsletter.

Results

Our response rate was 29% (n=88) of which 69 were orthopaedic surgeons and 17 were trauma surgeons. Early mobilization after trauma is advised by most of the respondents and seems to start after less than two weeks of immobilization for both conservatively treated patients (35.2%) and operatively treated patients (33.3%).

53.4% (n=49) advised starting PWB after 6-weeks for conservatively treated patients and 59.8% (n=52) for operative treatment (only osteosynthesis). A wide variation in usage of different types of exercises used after immobilization was found in both groups. The usage of a sling after operative treatment was advised by 86% (N=74) of all respondents.

Discussion/Conclusion

The present study found limited consensus about the aftercare and the role of PWB after trauma regarding PHF. More prospective convincing clinical outcome are needed to form an evidence based protocol focusing on the aftercare of PHF and to optimize patients" comfort.

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