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Fixation of a Fractured Humerus

Fracture humerus fixation surgery is a common procedure performed when you have broken the proximal (upper) part of your humerus (arm bone). Proximal humeral fracturesare divided by Neer’s classification into four categories:
  1. The humeral head
  2. The greater tubercle
  3. The lessertubercle
  4. The surgical neck
These fractures tend to occur in the elderly patient with the most common mechanism for fractures being falling on to an out stretched hand from standing or by direct trauma. In a majority of cases these fractures can be treated conservatively with a supportive sling and early rehabilitation. However, when these fractures are displaced (bones separated from each other), it is recommended to have surgery to reconnect and realign the bone.

There are different surgical options available to treat these fractures with the choice depending on severity of fracture, age and health of patient and time from injury to treatment. The operative treatments available are:
  • Open reduction internal fixation– the bones are reattached with a plate and screws
  • Humeral head replacement – usually performed in 4 part fractures (see shoulder hemiarthroplasty)
Attached to the surface of the proximal humerus are the rotator cuff muscles and as a result, fractures can cause significant damage to these muscles. It is critical for these muscles to be restructured if damaged as they are integral for stability of the joint and normal movement and function. It is therefore essential to undergo a comprehensive physiotherapy programme with to help restore and regain functional use of your arm.

Mobilisations of the glenohumeral joint by a MSK therapistAbove: Mobilisations of the glenohumeral joint by a MSK therapist

Physiotherapy prior toFixation of a Fractured Humerus

Physiotherapy prior to humerus fixation is a useful and recommended intervention. Not only will it help manage your immediate symptoms but will provide a solid platform for post surgical rehabilitation speeding up your rehab period and allowing you to maximise your rehab potential. Treatments offered include:

  • Cryotherapy
  • Pain management
  • Protective taping and bracing

Acute management of symptoms
  • Strengthening surrounding musculature
  • Advice on surgery and post-surgical management

Symptoms following Fixation of a Fractured Humerus

Following humerus fixation, your shoulder will be placed in a protective sling to help protect the new shoulder, aid recovery and maximise rehab potential. During this time you will be limited to the amount of movement allowed as well as the use of your arm. Symptoms that you may experience include:
  • Pain
  • Stiffness
  • Bruising
  • Swelling
  • Reduced strength
  • Neurological deficits – the main nerves of your arm lie close to the humerus and so can be damaged due to the fracture

Physiotherapy after Fixation of a Fractured Humerus

Following humerus fixation surgery a well planned physiotherapy programme designed with is critical for the success of the operation. will provide a thorough assessment and explanation of treatment as well as design a personal rehabilitation programme. Treatment will initially focus on acute management following surgery and progress on to regaining strength, range of movement and function.

Weeks 1-3

Initial treatment with will concentrate on minimising post operative complication, reducing acute symptoms and the initiation of movement. Treatment will include:
  • Cryotherapy
  • Pain Management
  • Sling use
  • Active exercises for elbow, wrist and hand
  • Active strength work for elbow, wrist and hand
  • Passive shoulder range of movement
  • Postural awareness
  • Scapular setting exercises
  • Wound management
  • Advice and education

Weeks 4-6

Following week 4 your sling use will be weaned and you will be encouraged to commence increased active range of motion to help reduce stiffness and strengthening exercises. will develop your programme with attention to personal requirements so that your surgery milestones are met. Treatment will include:
  • Increased passive range of movement
  • Begin active-assisted and active range of movement
  • Isometric strengthening of the shoulder
  • Scapular setting
  • Joint mobilisations
  • Proprioceptive training
  • Neurological mobilisations
  • Scar management

Weeks 7-12

Following week 7 will focus on a continuation and progression of exercises. Rehabilitation will begin to include specific exercises needed to perform functional activities and be directed to attaining full range of movement, improving muscular strength and endurance. Treatment will consist of:
  • Increased active and passive range of movement to attain full range
  • Rotator cuff strengthening
  • Stretching
  • Soft tissue massage
  • Muscular endurance
  • Increased proprioceptive training
  • Encourage functional activities

Weeks 12+

Following week 12, your movement and strength will be greatly improved and will be equal or close to your pre-operative state. Full recovery can take up to 12 months and so will provide a comprehensive long term rehabilitation programme for you to follow with a clear focus on maximising functional use of your arm. Treatment will include:
  • Attainment of full range of movement
  • Advanced strengthening of rotator cuff throughout range
  • Advanced proprioceptive exercises
  • Functional training
  • Long term management


Humeral fracture fixation is a common surgical procedure to realign and restore bony alignment following fracture of the humerus. These injuries can occur to all ages as a result of a fall or direct trauma and it is crucial to undergo surgery when this fracture is displaced. This injury can cause significant problems due to its responsibility as a site of muscle attachment and pathway for nerves. Physiotherapy is an essential component of rehabilitation and will provide a comprehensive and intense treatment programme to ensure the full recovery of movement strength and functional use of your arm. Call now on 0330 088 7800 for more information or to book an appointment please contact us.

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