Phase I: Protection and Early Recovery (0–2 Weeks)

Immobilisation:

• DIP joint immobilised in full extension using splint or K-wire fixation

• PIP joint and MCP joints left free for mobilisation

Precautions:

• Strictly avoid any DIP flexion

• Avoid gripping and lifting activities

• Maintain splint and pin site care as instructed

• Protect the fingertip from accidental impact

Therapy:

• Oedema management and elevation

• Active PIP and MCP joint range of motion

• Tendon gliding exercises

• Adjacent digit mobilisation

Criteria to Progress:

• Wound healing progressing appropriately

• Pain controlled

• Minimal swelling

• Full PIP joint motion maintained

Phase II: Restore Motion (2–6 Weeks)

Immobilisation:

• Continue DIP immobilisation in extension

• K-wire removal typically performed between 4–6 weeks where applicable

Precautions:

• Continue avoiding DIP flexion until cleared

• Avoid forceful gripping and pinch activities

• Avoid impact loading to the fingertip

• Protect fixation during daily activities

Therapy:

• Continue PIP and MCP joint mobilisation

• Oedema and scar management

• Commence gentle DIP flexion and extension following K-wire removal or surgeon clearance

• Continue tendon gliding exercises

Criteria to Progress:

• Fracture healing progressing clinically and radiographically

• Minimal swelling

• DIP extension maintained

• Gentle DIP motion tolerated

Phase III: Strength and Functional Recovery (6–12 Weeks)

Immobilisation:

• Night-time DIP extension splinting commonly continued for a further 6 weeks following K-wire removal or cessation of full-time splinting

Precautions:

• Avoid forceful DIP loading initially

• Avoid impact activities

• Progress loading gradually according to symptoms

Therapy:

• Progress DIP range of motion

• Gentle grip and pinch strengthening

• Dexterity and fine motor exercises

• Functional hand rehabilitation

Criteria to Progress:

• Functional DIP motion

• Minimal extension lag

• Improved grip and pinch strength

• Functional hand use restored

Phase IV: Return to Function and Endurance (3–6 Months)

Precautions:

• Gradual return to unrestricted hand use

• Avoid abrupt progression into forceful fingertip loading

Therapy:

• Progressive strengthening

• Functional rehabilitation

• Occupation-specific rehabilitation

• Sport-specific rehabilitation as required

Criteria to Progress:

• Fracture union achieved

• Stable DIP joint

• Functional strength restored

• Return to unrestricted activity

General Recommendations

Work:

• Office and sedentary work may resume as comfort allows

• Manual labour and forceful hand use are commonly delayed until approximately 8–12 weeks depending on fracture healing and occupational demands

Driving:

• It is important that you are medically fit to return to driving and you feel safe to control the vehicle and take evasive action if needed.

Sports and Leisure:

• Lower-limb and non-contact activities may resume as comfort allows.

• Progressive return to gym and functional hand activities from approximately 6–8 weeks.

• Contact sport, ball sports, climbing, or impact activities involving the hand are typically introduced from approximately 8–12 weeks or longer with full recovery and surgeon clearance.

Disclaimer: This protocol is intended as a general rehabilitation guide only. Rehabilitation progression should always be individualised and may be modified by A/Prof Ernstbrunner and the treating rehabilitation team based on the patient’s clinical progress, surgical findings, and individual circumstances.