Humeral Shaft Fracture — ORIF (Plate)

Wound Care

• An incision on the back or side of the upper arm. Keep dressings clean and dry for 3 days, then a dry dressing may be placed.

Arm Use & Sling

• Sling for comfort for 2–4 weeks — remove it several times daily for elbow, wrist, and hand motion.
• No lifting, pushing, or pulling more than a coffee cup with the surgical arm until healing is confirmed (typically ~6 weeks).
• Report immediately any new wrist weakness ("wrist drop") or numbness on the back of the hand — the radial nerve runs along this bone and we monitor it closely.

Physical Therapy Milestones

• Weeks 0–2: pendulum exercises, full elbow/wrist/hand motion out of the sling several times daily, grip exercises.
• Weeks 2–6: active shoulder motion progression as comfort allows; continue no-lifting rule.
• Weeks 6–12: strengthening begins once X-rays confirm healing — cuff and periscapular program, progressive functional use.
• Month 3+: return to full activity and sport as strength normalizes.

A therapist-facing version of this protocol is available at robertpettitmd.com/pt-protocols/humeral-shaft-orif.pdf — bring it to your first therapy visit.

Pain Control and Medications

You have been given a regional anesthetic block prior to your operation. This will wear off in the evening following your surgery.

1. Pain Medication: Tylenol 1000mg every 8 hours and, unless discussed otherwise, you have been prescribed a narcotic pain medication (Oxycodone 5mg) to take every 4-6 hours as needed.
• DO NOT drive/use any heavy machinery, drink alcohol, make any life-changing or legal decisions (i.e. sign a will), or participate in activities that require a lot of physical skill, as narcotics may change your mental acuity. On rare occasions they may cause confusion or disorientation, we advise you to discontinue this medication should that occur.
• Narcotics can be addictive. Dispose of any excess medication at a police/fire station.
• Take a stool softener (e.g. Colace) while taking narcotic medication, as narcotics may cause constipation.  If this does not help alleviate your constipation, you can try adding miralax or milk of magnesia. Please call our office if this regimen does not alleviate your constipation.
• If you have any questions or concerns about narcotic strength medications, please contact us.
• Journavx (suzetrigine): If Journavx has been prescribed, take it in place of the Oxycodone. Start with a loading dose of 100 mg (two 50 mg tablets), then take one 50 mg tablet twice a day (every 12 hours) for two weeks. If you are not getting adequate pain control with Journavx, you may take Oxycodone instead. Do not take Journavx and Oxycodone at the same time, and avoid grapefruit while taking Journavx.
2. Anti-nausea: Zofran (Ondansetron): Take as prescribed if needed for nausea
3. Anti-Inflammatory: Unless contraindicated due to other health reasons, you have been prescribed a non-steroidal anti-inflammatory drug (Ibuprofen 800mg) for use postoperatively. If you have no personal history of adverse response to anti-inflammatories (NSAIDs), take as prescribed every 8 hours with food to help reduce swelling and pain. Do not take other NSAIDs (Advil, Aleve, etc) with Ibuprofen.
4. DVT prophylaxis: Please take one 81 mg baby Aspirin twice daily for 30 days following surgery to help minimize the risk of blood clot (extremely rare). If not able to take aspirin you will be prescribed Lovenox (40 mg daily injection) or Eliquis (2.5 mg Twice daily) for 30 days. If you are already on anticoagulation then you do not need to take additional medications.

Tylenol and Ibuprofen are the foundation for your pain control regimen

Example dosing: 1000mg Tylenol then 4 hours later 800mg Ibuprofen then 4 hours later repeat- every 4 hours alternate between Tylenol and Ibuprofen. Oxycodone as needed for breakthrough pain.

*You should not exceed 3,000mg of Tylenol or 3,200mg of Ibuprofen in 24 hours.

Bathing, skin care:

• Do not take a bath, swim, sit in hot tub, or otherwise submerge your operative arm for 6 weeks after surgery unless otherwise directed. If scabs still exist on your wound do not submerge until cleared with Dr. Pettit. b. Generally, after 2 weeks you may begin to get the arm wet by letting water flow over it. Dr. Pettit will confirm this in the office and the incision should not be scrubbed until this discussion. If you have pins outside the skin, keep the foot dry at all times until the pins are removed in the office.
• Do not place any lotions, ointments, cleaning solutions, Vitamin E, or any other topical items on the arm after surgery unless instructed. These may compromise the surgical outcome.

Physical therapy:

• If your procedure requires therapy, a prescription will be given to you at one of the office visits after surgery. Some surgeries do not require physical therapy and some require immobilization for weeks before starting therapy. This is normal and failure to maintain immobilization before discussed may compromise the outcome of surgery.

Travel:

• Discuss any travel plans in the first weeks after surgery with Dr. Pettit. On long trips, get up and move regularly and stay well hydrated to minimize blood-clot risk.

Driving:

• When out of the sling for daily activities, off narcotic medication, and able to control the wheel confidently with both hands — typically 3–6 weeks.

Follow-up Appointment:

• Your first post-operative appointment will be scheduled 10–14 days following your surgical procedure. Typically dissolvable sutures are used during surgery, and do not need to be removed. If you do have sutures that need to be removed, this will occur at your first post-operative visit. If you do not have a post-operative appointment scheduled when you leave following surgery, please call 513-441-5639 to make the appointment.

****Signs & Symptoms to Immediately Report****

Call 911 and go to the nearest hospital if you are having chest pain or trouble breathing.