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  Data sources identified published (PUBMED, EMBASE, CINAHL) and unpublished (ClinicalTrials.gov, CENTRAL, NIHR Open Research, OpenGrey) literature.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

肱骨骨折后常推荐采取非负重方案。本综述旨在总结针对接受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、安全性及效果相关证据的范围与性质。本次研究检索了已发表于PUBMED、EMBASE、CINAHL的文献，以及未正式发表的ClinicalTrials.gov、CENTRAL、NIHR开放研究库（NIHR Open Research）、OpenGrey等平台的文献。由两名研究者独立完成数据提取工作，共检索到13901条记录，最终纳入10项研究，涉及515名术后患者与351名医疗保健从业者。9项研究证实EWB具备可行性；关于患者对EWB的依从性，现有证据较为有限。创伤与骨科医师认为EWB具备可接受性，但该结论取决于手术类型以及患者是否为术后多发伤病例；目前尚无来自患者视角的可接受性相关数据。仅1项研究提及2名患者因术后过度负重而出现不良结局。研究显示EWB可对残疾程度、疼痛症状、肩肘活动度及骨愈合产生积极影响。现有证据表明，肱骨骨折术后实施EWB具备可行性、安全性与有效性，但关于EWB可接受性的数据仍较为匮乏；且由于研究设计异质性较高、EWB方案存在差异，相关结论的推广性受到限制。现有部分证据支持肱骨骨折手术治疗后实施早期负重的可行性、安全性与有效性；部分骨科亚专科医师认为部分肱骨骨折患者可采取早期负重方案，但该方案尚未获得普遍认可。康复从业者应与肱骨骨折手术患者及其多学科团队讨论早期负重方案的可行性。现有部分证据支持肱骨骨折手术治疗后实施早期负重的可行性、安全性与有效性；部分骨科亚专科医师认为部分肱骨骨折患者可采取早期负重方案，但该方案尚未获得普遍认可。康复从业者应与肱骨骨折手术患者及其多学科团队讨论早期负重方案的可行性。