Duration of Immobilization: Affect Humeral Fracture Outcomes?

The duration of immobilization for nonoperatively treated proximal humeral fractures doesn’t seem to impact outcomes, a new study suggests.

In the study, “One Versus 3-Week Immobilization Period for Nonoperatively Treated Proximal Humeral Fractures,” published on August 18, 2021 in The Journal of Bone and Joint Surgery, the researchers conducted a prospective randomized trial to determine whether a 1-week immobilization or 3-week immobilization would be more effective when it came to pain and functional outcomes.

“There is no consensus on the duration of immobilization for nonoperatively treated proximal humeral fractures. The main objective of the study was to determine the differences in pain between proximal humeral fractures that were treated with 1-week immobilization.”

The researchers assessed pain using a 10-cm Visual Analog Scale that was administered 1 week and 3 weeks after the fracture and then at the 3,6, 12 and 24-month follow-up. The functional outcome was evaluated using the Constant score.

The functional disability of the shoulder was determined using a self-reported shoulder-specific questionnaire—the Simple Shoulder Test. Both the Constant score and the Simple Shoulder Test were recorded at the 3, 6, 12 and 24-month follow-up periods. The researchers also reported complications and secondary displacement.

Overall, 111 patients (88 females and 23 males) were enrolled in the final analysis. They were randomized to either 1-week immobilization or 3-week immobilization. The mean age of the patients was 70.4 years.

There was no significant differences found between the 2 groups when it came to pain as measured with the Visual Analog Scale at any point (1 week [5.9 versus 5.6; p = 0.648], 3 weeks [4.8 versus 4.1; p = 0.059], 3 months [1.9 versus 2.4; p = 0.371], 6 months [1.0 versus 1.2; p = 0.605], 1 year [ 0.65 versus 0.66; p = 0.718], and 2 years [0.63 versus 0.31; p = 0.381]).

Neither were there any significant differences in the Constant score or the Simple Shoulder Test scores between the two groups. Complication rates were also similar.

“Short and long periods of immobilization yield similar results for nonoperatively treated proximal humeral fractures, independent of the fracture pattern. These fractures can be successfully managed with a short immobilization period of 1 week in order to not compromise patients’ independence for an overly extended period,” the researchers wrote.