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

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.  Data sources identified published (PUBMED, EMBASE, CINAHL) and unpublished (ClinicalTrials.gov, CENTRAL, NIHR Open Research, OpenGrey) literature.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. 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. 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. 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. 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.

肱骨骨折术后常推荐患肢不负重。本综述旨在总结手术或非手术治疗的肱骨骨折患者实施早期负重（early weight bearing, EWB）的可行性、可接受性、安全性及疗效相关证据的范围与性质。
本研究的数据来源涵盖已发表文献（PUBMED、EMBASE、CINAHL）及未发表文献（ClinicalTrials.gov、CENTRAL、NIHR Open Research、OpenGrey）。由两名研究者独立开展数据提取工作，共检索到13901条记录，最终纳入10项研究，涉及515名术后患者及351名医疗专业人员。
9项研究证实EWB具备可行性。关于EWB的依从性相关证据较为有限。创伤骨科医师认为EWB具备可接受性，但该结论受手术类型及是否为术后多发伤病例影响。目前尚未有患者视角下的可接受性相关数据报道。仅1项研究提及2名患者因术后过度负重出现不良结局。
研究表明，EWB可对残疾程度、疼痛、肩肘关节活动度及骨愈合产生积极影响。
现有部分证据支持肱骨骨折术后EWB的可行性、安全性与有效性，但EWB可接受性相关数据仍较为匮乏。由于研究设计异质性较高且EWB方案存在差异，相关研究结论的普适性受到限制。
现有部分证据支持肱骨骨折手术治疗后早期负重具备可行性、安全性与有效性。部分骨科亚专业医师认可部分肱骨骨折术后实施早期负重，但该方案尚未获得普遍认可。康复专业人员应与患者及其多学科团队讨论肱骨骨折术后实施早期负重的可行性方案。
现有部分证据支持肱骨骨折手术治疗后早期负重具备可行性、安全性与有效性。部分骨科亚专业医师认可部分肱骨骨折术后实施早期负重，但该方案尚未获得普遍认可。康复专业人员应与患者及其多学科团队讨论肱骨骨折术后实施早期负重的可行性方案。