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

Immobilisation:

• Thumb spica cast

• Cast maintained until hand therapy review

Precautions:

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

• Keep cast clean and dry

• Avoid smoking where possible due to increased risk of non-union

Therapy:

• Finger, elbow, and shoulder range of motion exercises

• Oedema control and elevation

• Maintain mobility of uninvolved joints

Criteria to Progress:

• Healing wound

• Controlled pain and swelling

• Stable fixation clinically and radiographically

Phase II: Continued Protection and Progressive Motion (2–8 Weeks)

Immobilisation:

• Transition to fiberglass or thermoplastic thumb spica at approximately 2 weeks postoperatively

• Total immobilisation period typically 8 weeks from date of surgery

Precautions:

• Avoid gripping, lifting, or axial loading through the wrist

• Avoid forceful thumb or wrist motion

Therapy:

• Continue finger, elbow, and shoulder mobility exercises

• Oedema management

• Maintain general upper limb mobility

Criteria to Progress:

• Minimal pain at fracture site

Phase III: Progressive Motion and Early Strengthening (8–12 Weeks)

Precautions:

• Avoid heavy lifting or impact loading early in this phase

Therapy:

• Commence wrist and thumb range of motion exercises

• Gradual progression of forearm rotation

• Gentle grip and strengthening exercises

• Functional hand and wrist exercises

Criteria to Progress:

• Improving range of motion

• Minimal pain

• Radiographic progression of union

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

Precautions:

• Gradual return to heavier loading activities

Therapy:

• Progressive strengthening and endurance training

• Functional and task-specific rehabilitation

• Return to sport-specific activities as appropriate

• 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 after 1–2 weeks if pain is well controlled

• Manual labour should be deferred until 3–6 months depending on fracture healing 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 resume following cast removal.

• Progressive return to functional and light activities from 8–12 weeks.

• Heavier gripping and lifting from approximately 12–16 weeks as comfort allows.

• Higher-demand hand use, contact, or impact activities typically from 3–6 months depending on fracture healing 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.