Wound Care

• Remove dressing in 7 days.
• You have a mepilex dressing that is ok waterproof. Glue applied underneath
• You may shower 3 days after your surgery; be sure to pat the dressing dry afterwards.
• Do not scrub the area; just allow water/soap to wash over you.
• Do not soak or swim until approved by surgeon.

Ice

• We recommend that you use ice on a consistent basis for the first 24–48 hours.
• Following
• This will help reduce post-operative swelling. After that, use as necessary.
• Use a cloth between the ice and your skin. DO NOT place ice directly on skin as this may cause frostbite. Do not leave ice wrap or cold therapy on for more than 20 minutes without checking your skin.

Physical Therapy

• Typically, no Formal Physical therapy is needed. You will be given exercises to do on your own at your first post-operative appointment.

Sling & Weight bearing status

• With a proximal humerus fixation, you will be placed in a sling.
• You need to wear the sling for 4-6 weeks. It should only be removed for showering and for your exercises.
• You should not bear weight with your arm or use your arm to lift anything until instructed by Dr. Pettit.
• Sling should be worn at bedtime and outside of the home for the first 6 weeks after surgery. During those 6 weeks, it does not need to be worn while you are at home or you are eating/drinking, however, it is very important to avoid rotating your hand away from your body.
• Sling should be worn at bedtime and outside of the home for the first 6 weeks after surgery. It does not need to be worn while you are at home or you are eating/drinking, however, it is very important to avoid rotating your hand away from your body. Please see the picture to the right as a reference of maintaining neutral shoulder rotation. The hand of your operative arm should remain in the box, and in front of you at all times.
• If you are wearing your sling at all times for comfort, it is important to come out of your sling 3-4 times a day to straighten your elbow and move your wrist and fingers to avoid stiffness.
• Until you are more comfortable you will need some help to remove your sling. You will need to unclip the shoulder strap and the Velcro strap across your forearm. Be sure to support your arm while the sling is being removed and put back on. Do not actively move your shoulder to remove your sling.
• Perform these exercises 2-3 times per day with 10 repetitions per session.
• Encourage early range of motion of your elbow, wrist, and hand. Please begin this immediately.

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. You may find it beneficial to sleep in a recliner after 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, esp. with narcotics.
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. Muscle Relaxer: Cyclobenzaprine (Flexeril) will be prescribed for patients <70yo for muscle spasms as needed. You may take 5-10mg of Flexeril every 8 hours for muscle spasm as needed.

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.

Driving

• Driving may resume when you are 4-6 weeks post operatively, and able to remove your sling. You may not return to driving while still taking narcotics. You must feel safe to operate a vehicle. We recommend you practice driving in an open parking lot before returning to the road. If you have to drive for long periods of time within 2-4 weeks after surgery, we recommend taking frequent breaks to walk and stretch, to decrease the risk of a blood clot.

Return to Work

• You may return to work as soon as you are comfortable. This is dependent on your job type. You will not be able to return to work with heavy lifting until 4-6 months post-op. Return to work notes can be obtained at your first post-op appointment.

Follow-up Appointment

• Your first post-operative appointment will be scheduled 7-10 days following your surgical procedure. 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.