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 |