Skip to main content

Table 1 Rehabilitation protocol

From: Surgical versus non-surgical treatment of humeral SHAFT fractures compared by a patient-reported outcome: the Scandinavian Humeral diAphyseal Fracture Trial (SHAFT)—a study protocol for a pragmatic randomized controlled trial

Phases (approx. timepoints)

Treatment (mobilization)

Explanation

Non-surgical

 Phase 1

Emergency department (ED)

(0 weeks)

Apply immobilization device.

(Wrist and fingers are recommended to be moved within immobilization device for anti-edema).

Immobilization device should not be taken off (dressing, hygiene). Await decrease of swelling and acute pain

 Phase 2

(0–2 weeks)

Shift to brace, if not applied in ED.

Physiotherapy can be introduced.

(Unrestricted and unloaded active range of motion within the limitations of the brace are allowed).

Brace should always be carried.

Patients allowed to lift objects, equivalently to a can of milk (max 1 kg).

Physiotherapy can be started to introduce simple movements.

 Phase 3a

(6 weeks, can be extended to a maximum of 12 weeks)

Fracture is tested gently for instability in patients 18–64 years.

If stable, continue to phase 4.

If unstable or uncertain stability, return to phase 2 and extend period with brace or consider early crossover surgery.

a. The fracture is not sufficiently healed and needs more time with brace treatment.

b. The fracture is grossly unstable and there is a risk of nonunion. Surgical fixation could be beneficial.

 Phase 3b

(12 weeks, can be extended to a maximum of 26 weeks)

Fracture is tested gently for instability in patients ≥ 65 years.

If stable, continue to phase 4.

If unstable or uncertain stability, return to phase 2 and extend period with brace or consider early crossover surgery.

a. The fracture is not sufficiently healed and needs more time with brace treatment.

b. The fracture is grossly unstable and there is a risk of nonunion. Surgical fixation could be beneficial.

Phase 4

(Patients < 65 years: 6–12 weeks)

(Patients > 65 years: 12–26 weeks)

Brace is removed. Continue physiotherapy.

(Unrestricted active range of motion of shoulder and elbow with gradual loading).

Fracture is clinically healed.

Physiotherapy to regain full range of motion and strength. Movements should be within the threshold of pain.

Surgical

 Phase 1

(0 weeks)

Apply immobilization device.

(Wrist and fingers are recommended to be moved within immobilization device for anti-edema).

Immobilization device should not be taken off (dressing, hygiene). Await date of surgery.

 Phase 2

(0–2 weeks)

Surgical treatment.

Physiotherapy can be introduced.

(Unrestricted active range of motion, unloaded).

Patients allowed to lift objects, equivalently to a can of milk (max 1 kg). Caution due to wound healing

 Phase 3

(6 weeks)

Continue physiotherapy.

(Unrestricted active range of motion, starting gradual loading).

Movements should be within the threshold of pain

 Phase 4

(7 weeks)

Continue physiotherapy.

(No restrictions, active range of motion with full load).

Physiotherapy to regain full range of motion and strength