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

Immobilisation:

• Long-forearm splint

• Elevation encouraged to reduce oedema

Precautions:

• Avoid lifting, gripping, and weight-bearing through the wrist

• Protect the fusion site and soft tissues

• Avoid forceful finger or forearm loading

Therapy:

• Finger and thumb range of motion exercises

• Elbow and shoulder mobilisation

• Oedema control and wound care

• Tendon gliding exercises

• Maintain mobility of uninvolved joints

Criteria to Progress:

• Healing wound

• Controlled pain and oedema

• Good finger mobility

Phase II: Continued Protection and Progressive Motion (2–6 Weeks)

Immobilisation:

• Transition to fiberglass below-elbow cast at approximately 2 weeks

• Continue immobilisation until 6 weeks postoperatively

Precautions:

• Avoid lifting, gripping, or weight-bearing through the wrist

• Avoid forceful wrist motion

• Avoid impact loading

Therapy:

• Continue finger and thumb range of motion

• Continue elbow and shoulder mobilisation

• Oedema management

• Maintain tendon mobility

Criteria to Progress:

• Minimal pain and swelling

• Radiographic progression of fusion

• Good digital motion

Phase III: Progressive Motion and Early Strengthening (6–12 Weeks)

Immobilisation:

• Discontinue cast and transition to removable wrist splint as required

Precautions:

• Avoid heavy gripping and loading early in this phase

• Avoid repetitive impact activities

Therapy:

• Commence wrist active range of motion exercises

• Gentle forearm rotation exercises

• Progressive functional hand use

• Commence light grip strengthening

• Gradual progression of activities of daily living

Criteria to Progress:

• Improving wrist motion

• Minimal pain

• Radiographic progression towards union

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

Precautions:

• Gradual return to heavier activities

• Avoid excessive repetitive loading until fusion established

Therapy:

• Progressive strengthening and endurance training

• Functional and task-specific rehabilitation

• Gradual return to work and recreational activities

• Criteria for Return to Activity

• Radiographic union

• Functional range of motion

• Good strength and endurance

• No significant pain or swelling

General Recommendations

Work:

• Desk-based work may resume after 1–2 weeks depending on comfort.

• Manual work is typically deferred until 3–6 months depending on fusion progression and job 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 activities may resume as comfort allows.

• Light hand use may commence following cast removal as directed.

• Progressive return to functional and gym activities from approximately 3 months.

• Higher-demand wrist loading, racquet sports, or impact activities typically from 4–6 months 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.