الفهرس 
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Abstract
The proximal humerus fracture is the most common fracture of the shoulder. It is a partial or complete break in the upper end of the humerus. Fracture of the proximal humerus and humeral head are most common injuries worldwide, it accounts for 5 - 15% of all fractures in adult.
Patients with humeral fracture are often in poor general health and have reduced neuromuscular function. The frailty of these patients leaves them susceptible to further injury and it is therefore important that they to be rehabilitated as quickly as possible. The primary goals of the rehabilitation exercises is to control pain, protect tissue during healing process, restore function and avoid recurrence of symptoms . Therefore, immediate rehabilitation offers the best chance of regaining function in the shortest possible time.
The aim of this study was
To determine the effect of a rehabilitation program on the functional ability and healing process of patients with proximal humerus fracture
Materials and methods:-
• Materials
The study was carried out in casualty, inpatient and outpatients units of Hadara Orthopedic and Traumatology University Hospital. A sample of convenience comprised 40 adult patients of both sexes with proximal humerus fracture treated either by conservative or surgical method and Free from any associated disorders. Two tools were used to determine the effect of rehabilitation program on functional ability of the joint and healing process of fracture. Tool I: Shoulder function ability index include four parts: part I sociodemographic and clinical data, Part II: Shoulder functional ability checklist, Part III: Pain scale and Part IV: Shoulder plain X ray. Tool II: Mobility index of the shoulder include two parts: Part I: Rang of motion of the affected shoulder and Part II: Muscle strength scale of the affected shoulder.
• Methods
Convenience forty adult patients who follow the inclusions criteria were assigned randomly, alternatively and equally into two groups 20 patients in each immediately on admission. Biosociodemographic and clinical data were obtained from all patients participating in the study on the first day of admission. Patients of both groups were assessed immediately on admission using the two tools prior to starting of the exercise program through individual interviewing. Patients in the control group II was only exposed to routine hospital care as carried out by ward medical and nursing staff. The exercise program was carried out by the researcher in the emergency or inpatient department to each patient individually of the study group I. It was consisted of verbal instruction using demonstration and redemonstration.
In addition, illustrated colored booklet was distributed to each patient as a reference. Patients were asked to repeat the exercises until the investigator was assured that the patient has gained the skills. Patient of the study group was asked to bring one of the educated family members to attend the program. Patients were followed weekly on the outpatient unit for six weeks to be sure that patients followed the instruction given to them correctly. Evaluation was done after three weeks and at the end of the rehabilitation program for both groups for functional ability, degree of pain, joint range of motions and muscle strength. Evaluation was done also about healing process three, six and eight weeks post rehabilitation program. Comparison was done between two groups to identify the effect of the rehabilitation program on the functional ability and healing process among patients with proximal humerus fracture.
The main results of the study were:
1- The majority of the patients age (60%) were in the age group of 50≤60 years
2- Female patients represented higher percentage (62.5%) than male patients (37.5%)
3- Illiterate patients formed the greatest proportion of the sample (72.5%).
4- Housewife represented the highest percent (62.5%)
5- Two part fractures represented the highest percent (37.5%)
6- More than half of the sample (60%) was left side affected.
7- The majority (42.5%) of patients fracture were caused by falling in outstretched hand
8- The highest percent of the sample (42.5%) were treated conservatively with sling
9- After three and six weeks of rehabilitation , there was statistically significant difference in the shoulder functional ability score between the study and control groups
10- After three and six weeks of rehabilitation program the mean percent shoulder functional ability score of the study group was significantly higher than that of the control group.
11- After six weeks of rehabilitation program there was statistically significant difference in Shoulder functional ability score between the study and control group.
12- After three and six weeks of rehabilitation program there was statistically significant difference in the mean pain score between the study and control group. The lowest mean pain score was presented in the study group.
13- After eight weeks of rehabilitation all the study group (100%) had union as compared to (50%) of the control group
14- After three and six weeks of rehabilitation program, study group had higher percentage of maximum degree of motion than their control group
15- After three and six weeks of rehabilitation program, study group had stronger muscle strength than control group.
Conclusion:
In conclusion the result of this study denotes that using the rehabilitation program following proximal humerus fractures is effective in improving shoulder functional ability, range of motion, muscle strength and healing process as well as decrease feeling of pain post fractures.
Recommendations:
4- Patients with proximal fracture should be informed to follow the rehabilitation program immediately post fracture for six weeks.
5- A colored illustrated booklet about exercises program should be available and distributed to each patients post fracture treatment.
6- A procedure manual should be available to each nurse working in the orthopedic department about exercises program.