Clavicle ORIF Protocol

Open reduction and internal fixation (ORIF) of the clavicle is performed to restore alignment and stabilize a fractured collarbone using a plate and screws. This surgical intervention allows for early mobilization of the upper extremity, preventing joint stiffness and muscle atrophy. The primary objective of this rehabilitation protocol is to protect the surgical hardware and bone fixation during early healing while gradually restoring full range of motion, muscle strength, and functional stability of the shoulder complex.

Phase 1: Protection and Early Motion (Weeks 0 - 2)

Goals:

• Protect the surgical hardware and bone fixation
• Control post-operative pain and swelling
• Maintain active range of motion of the elbow, wrist, and hand
• Promote gentle passive and active-assisted shoulder motion within safe limits

Precautions & Restrictions:

• Wear the sling at all times, including during sleep, except for hygiene and prescribed exercises
• No active shoulder elevation or abduction of the surgical arm
• No lifting of any objects with the surgical arm
• No weight bearing or pushing/pulling through the surgical arm
• Avoid sleeping on the operative side

Suggested Exercises:

• Active range of motion (AROM) of the elbow, wrist, hand, and fingers
• Pendulum exercises (gentle circular movements) to prevent shoulder stiffness
• Gentle scapular shrugs, retraction, and depression (avoiding aggressive retraction that stresses the clavicle)
• Passive shoulder flexion to 90 degrees and external rotation to 30 degrees (performed in a pain-free range)

Criteria to Progress:

• Pain and swelling are well-controlled
• Compliance with sling wear and post-operative precautions
• Incision is healed with no signs of active infection

Phase 2: Active-Assisted to Active ROM (Weeks 2 - 6)

Goals:

• Gradually restore full passive range of motion (PROM)
• Initiate and progress active-assisted (AAROM) and active range of motion (AROM)
• Restore normal scapular mechanics and stability
• Wean off the sling by weeks 4 to 6 under surgeon guidance

Precautions & Restrictions:

• Discontinue the sling gradually between weeks 4 and 6 as tolerated
• No lifting of objects greater than 2 to 5 pounds with the surgical arm
• No sudden jerking, pulling, or pushing movements
• Avoid excessive horizontal adduction and stretching at end-range

Suggested Exercises:

• Active-assisted shoulder range of motion (AAROM) using a wand or pulley system (flexion, abduction, internal/external rotation)
• Active range of motion (AROM) of the shoulder in flexion, abduction, and scaption, starting in supine and progressing to standing
• Submaximal isometric exercises (flexion, extension, abduction, external/internal rotation) starting around week 4
• Scapular strengthening: rows, retraction, and depression exercises using light resistance or body weight

Criteria to Progress:

• Shoulder flexion active range of motion (AROM) to at least 140 degrees
• Minimal pain during active range of motion
• Evidence of early radiographic healing on follow-up X-rays

Phase 3: Progressive Strengthening (Weeks 6 - 12)

Goals:

• Achieve full, pain-free active range of motion in all planes
• Normalize scapulohumeral rhythm during elevation
• Initiate progressive strengthening of the rotator cuff, deltoid, and scapular stabilizers
• Gradually restore light functional usage of the extremity

Precautions & Restrictions:

• No heavy lifting, carrying, or pushing (greater than 10 to 15 pounds) until bone healing is secure
• Avoid high-impact activities, contact sports, and fall risks

Suggested Exercises:

• Progressive resistance exercises (PREs) for the rotator cuff and scapular muscles using resistance bands (Therabands)
• Light dumbbell exercises (e.g., scaption, prone rows, horizontal abduction)
• Closed chain exercises: wall push-ups, table push-up plus
• Core and lower body conditioning to support shoulder mechanics

Criteria to Progress:

• Full pain-free active range of motion of the shoulder
• Normal scapulohumeral rhythm throughout the range of motion
• No tenderness over the fracture site
• Radiographic confirmation of complete clavicular union

Phase 4: Advanced Conditioning & Return to Activity (Weeks 12+)

Goals:

• Restore maximum strength, power, and muscular endurance
• Optimize dynamic shoulder stability in high-demand positions
• Gradually transition back to full work, recreational activities, and sports

Precautions & Restrictions:

• Gradual exposure to contact sports or high-impact training only after explicit surgeon clearance
• Modify activity immediately if pain or significant fatigue occurs

Suggested Exercises:

• Advanced dynamic strengthening including progression of weight training exercises (overhead press, bench press as tolerated)
• Plyometric training (e.g., medicine ball throws, wall bounces) for athletic patients
• Sport-specific or work-specific rehabilitation drills and movement patterns
• Continued maintenance program of rotator cuff and scapulothoracic conditioning

Criteria to Progress:

• Full strength and endurance comparable to the uninjured side (at least 85-90%)
• Complete radiographic union and clinical stability
• Clearance from the orthopedic surgeon for unrestricted activity

These guidelines represent a standard rehabilitation protocol. Individual recovery rates vary significantly depending on the size of the repair, bone/tissue quality, and general patient health. Your surgeon may modify this protocol specifically for you.

Disclaimer: This protocol is for educational purposes and is not a substitute for professional medical advice. Always consult your surgeon or physical therapist before performing any exercises or modifying activity restrictions.