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

Immobilisation:

• Protective hand-based splint in intrinsic-plus position.

• Removed for supervised exercises as directed.

Precautions:

• Avoid heavy gripping, lifting, or impact activities

• Protect wound and fixation

• Elevate hand to minimise swelling

Therapy:

• Early finger range of motion exercises as tolerated

• Oedema control and wound care

• Tendon gliding exercises

• Maintain wrist, elbow, and shoulder mobility

Criteria to Progress:

• Healing wound

• Controlled pain and swelling

• Improving finger motion

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

Immobilisation:

• Transition out of splint as directed

Precautions:

• Avoid forceful gripping or heavy loading

• Avoid contact or impact activities

Therapy:

• Progress active and passive finger range of motion

• Continue tendon gliding and oedema management

• Commence gentle functional hand use

• Light strengthening exercises as tolerated

Criteria to Progress:

• Functional range of motion

• Minimal swelling

• Stable fixation clinically and radiographically

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

Precautions:

• Avoid sudden increases in loading

Therapy:

• Progressive grip and pinch strengthening

• Functional and task-specific exercises

• Gradual return to lifting and manual activities

Criteria to Progress:

• Good strength and hand control

• Minimal pain

• Radiographic progression of union

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

Precautions:

• Gradual return to higher-demand activities

Therapy:

• Continued strengthening and endurance training

• Return to full functional and recreational activities as tolerated

• Criteria for Return to Activity

• Radiographic union

• Functional range of motion

• Good strength and control

• No pain at fracture site

General Recommendations

Work:

• Office/desk work may resume immediately if pain is well controlled

• Manual labour should be deferred until 6–12 weeks depending on 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 resume as tolerated within the first 1–2 weeks.

• Progressive return to functional and light activities from 4–6 weeks.

• Heavier gripping and lifting from approximately 6–8 weeks as comfort allows.

• Higher-demand hand use, contact, or impact activities typically from 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.