Physiotherapeutic interventions and rehabilitation regimen of the surgically stabilized proximal humeral fracture – a literature review

Proximal humeral fractures requiring surgical stabilization remain a therapeutic challenge, and a fully functioning joint is rarely the outcome after traumatic proximal humeral fractures. A systematic review was conducted to present the current state of knowledge concerning the postoperative rehabilitation. Tree databases was searched (PubMed, PEDro and the Cochrane library), presenting 25 publications eligible for further review and assessment. The literature was evaluated using PEDro and The Swedish Council on Health Technology, SBUs, evaluation grading system GRADE. The main functional impairments were pain and reduced range of motion in the shoulder joint, and were measured by several different scoring systems for functional outcome. Reported results were contradictory and inconsistent, and current studies typically lack randomization, and independent evaluation, with a resultant inability to produce clinical conclusions. According the post-operative rehabilitation procedure, only careful conclusions can be drawn from the literature reviewed which does not focus on, emphasize or explore the physiotherapeutic interventions at any length. It was therefore not possible to compare or connect the Axelina rehabilitation regimen with the literature. The Axelina rehabilitation program of the shoulder joint, are the most commonly used regimen at the physiotherapeutic ward at Uppsala University hospital. Neither was it possible to determine if the post-operative treatment should be different according to classification of fracture or method of stabilization. The results from this systematic review suggest that the data from the published literature are inadequate for evidence-based decision making as regards the treatment and post-operative rehabilitation for complex proximal humeral fractures