Proximal Humerus Open Reduction Internal Fixation Post-Op Instructions

1. DIET

• Begin with clear liquids and light foods (Jell-o, soups, etc.)
• Progress to your normal diet if you are not nauseated

2. WOUND CARE

• Maintain your operative dressing, loosen bandage if swelling of the elbow, wrist, or hand occurs
• It is normal for the shoulder to bleed and swell following surgery – if blood soaks through the bandage, do not become alarmed – reinforce with additional dressing
• Remove surgical dressing on the 3rd post-operative day – if minimal drainage is present, apply band-aids over incisions and change daily
• To avoid infection, keep surgical incisions clean and dry – you may shower by placing a large garbage bag over your sling starting the day after surgery – NO immersion of operative arm (i.e. bath)

3. MEDICATIONS

• Pain medication is injected into the wound and shoulder joint during surgery – this will wear off within 8-12 hours
• Most patients will require some narcotic pain medication for a short period of time – this can be taken as per directions on the bottle
  • Primary Medication = Oxycodone
  • Take 1 – 2 tablets every 4 – 6 hours as needed
  • Max of 12 pills per day
  • Plan on using it for 2 to 5 days, depending on level of pain
• Common side effects of the pain medication are nausea, drowsiness, and constipation – to decrease the side effects, take medication with food.
• If constipation occurs, consider taking an over-the-counter laxative
• If you are having problems with nausea and vomiting, contact the office to possibly have your medication changed
• Do not drive a car or operate machinery while taking the narcotic medication
• Ibuprofen 400-600mg (i.e. Advil) may be taken in between the narcotic pain medication to help smooth out the post-operative ‘peaks and valleys’, reduce overall amount of pain medication required, and increase the time intervals between narcotic pain medication usage.

4. ACTIVITY

• When sleeping or resting, inclined positions (i.e. reclining chair) and a pillow under the forearm for support may provide better comfort
• Do not engage in activities which increase pain/swelling (lifting or any repetitive above shoulder level activities) over the first 7-10 days following surgery
• Avoid long periods of sitting (without arm supported) or long distance traveling for 2 weeks
• NO driving until instructed otherwise by physician
• May return to sedentary work ONLY or school 3-4 days after surgery, if pain is tolerable

5. IMMOBILIZER

• Your immobilizer should be worn at all times except for hygiene and exercise
• Plan to wear sling for the first 4-6 weeks post-operatively

6. ICE THERAPY

• Begin immediately after surgery
• Use icing machine continuously or ice packs (if machine not prescribed) every 2 hours for 20 minutes daily until your first post-operative visit – remember to keep arm supported while icing
• DonJoy Ice Machine device may be used.
  • Use unit as frequently as tolerated x 14 days
  • Unit is programmed hour on/hour off continuous of compression and ice alternating
  • If braced* - Loosen brace to avoid added pressure
• If issues with ice machine device, please contact DonJoy directly

7. EXERCISE

• No exercises or shoulder motion until after your first post-operative visit unless otherwise instructed
• You may begin elbow, wrist, and hand range of motion on the first postoperative day about 2-3 times per day
• Formal physical therapy (PT) will begin withing 7-14 days post-op

8. EMERGENCIES

• Contact Dr. Howard or his staff at if any of the following are present:
  • Painful swelling or numbness
  • Unrelenting pain
  • Fever (over 101° - it is normal to have a low grade fever for the first day or two following surgery) or chills
  • Redness around incisions
  • Color change in wrist or hand
  • Continuous drainage or bleeding from incision (a small amount of drainage is expected)
  • Difficulty breathing
  • Excessive nausea/vomiting
• **If you have an emergency after office hours or on the weekend, contact the same office number ( and you will be connected to our page service)
• ***If you have an emergency that requires immediate attention, proceed to the nearest emergency room.

9. FOLLOW UP CARE + QUESTIONS

• Typically the first post-operative appointment following surgery is 10-14 days following surgery
• If you do not already have a postoperative appointment scheduled, please contact the office during normal office hours (831-648-7200) and ask for appointment scheduling.
• The first post-operative appointment will be with Dr. Howard where he will assess the wound, go over post-operative protocol, and answer any questions you may have regarding the procedure