The feasibility, acceptability, safety, and effects of early weight bearing in humeral fractures - a scoping review

Jia Hui Gan; Lindsay Bearne; Samuel Walters; Jon Room; Greg Booth; Alex Trompeter; Dimitra Nikoletou

doi:10.1080/09638288.2024.2351594

The feasibility, acceptability, safety, and effects of early weight bearing in humeral fractures - a scoping review

Disabil Rehabil. 2024 May 16:1-12. doi: 10.1080/09638288.2024.2351594. Online ahead of print.

Authors

Jia Hui Gan^{1

2

3}, Lindsay Bearne², Samuel Walters⁴, Jon Room^{5

6}, Greg Booth^{2

7}, Alex Trompeter^{3

4}, Dimitra Nikoletou³

Affiliations

¹ Haslemere Community Hospital, Royal Surrey NHS Foundation Trust, Surrey, UK.
² Population Health Research Institute, St George's University of London, London, UK.
³ Institute of Medical and Biomedical Education, St George's University of London, London, UK.
⁴ Department of Trauma and Orthopaedic Surgery, St George's University Hospitals NHS Foundation Trust, London, UK.
⁵ Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.
⁶ Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁷ Therapies Department, Royal National Orthopaedic Hospital Trust, London, UK.

PMID: 38753460
DOI: 10.1080/09638288.2024.2351594

Abstract

Purpose: Non-weight bearing is often recommended after humeral fractures. This review aims to summarise the extent and nature of the evidence for the feasibility, acceptability, safety, and effects of early weight bearing (EWB) in people with humeral fractures, treated operatively or non-operatively. .

Methods: Data sources identified published (PUBMED, EMBASE, CINAHL) and unpublished (ClinicalTrials.gov, CENTRAL, NIHR Open Research, OpenGrey) literature. Independent data extraction was conducted by two reviewers.

Results: 13 901 records were retrieved. Ten studies, involving 515 post-operative patients and 351 healthcare professionals, were included. EWB was found to be feasible in nine studies. There was limited evidence regarding adherence to EWB. Trauma and orthopaedic surgeons reported that EWB was acceptable. This depended on surgery type and whether it was a post-operative polytrauma case. No acceptability data was reported from patients' perspectives. Only one study reported two patients who developed unsatisfactory outcomes from excessive post-operative EWB. Positive effects of EWB were reported on disability level, pain, shoulder and elbow motion, and union.

Conclusion: There is some evidence for the feasibility, safety, and effectiveness of post-operative EWB after humeral fractures. There was limited data on the acceptability of EWB. Heterogeneous study designs, and variations in EWB protocols limit conclusions.

Keywords: Scoping review; early weight bearing; humeral fractures; immediate weight bearing; rehabilitation.

Plain language summary

There is some evidence to support the feasibility, safety, and effectiveness of early weight bearing following operative management of humeral fractures.Early weight bearing after some humeral fractures is acceptable to some subspecialities of orthopaedic surgeons but is not universally accepted.Rehabilitation professionals should discuss the option of early weight bearing after operative management of humeral fracture with patients and their multidisciplinary team.