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

Immobilisation:

• Long-forearm cast or splint

• Elevation encouraged to reduce oedema

Precautions:

• Avoid lifting, gripping, and weight-bearing through the operated limb

• Protect the osteotomy site and fixation

• Avoid forceful forearm rotation

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: Progressive Motion and Protection (2–6 Weeks)

Immobilisation:

• Transition to removable wrist splint at approximately 2 weeks

Precautions:

• Avoid heavy lifting and gripping

• Avoid impact loading

• Avoid forceful forearm rotation

Therapy:

• Commence wrist and forearm active range of motion exercises

• Gradual progression of pronation and supination

• Continue oedema management

• Functional hand use for light daily activities

• Maintain elbow and shoulder mobility

Criteria to Progress:

• Improving wrist and forearm motion

• Minimal pain and swelling

• Stable fixation clinically and radiographically

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

Immobilisation:

• Wean splint progressively as control improves

Precautions:

• Avoid sudden increases in loading

• Avoid repetitive heavy lifting early in this phase

Therapy:

• Progress wrist and forearm range of motion

• Commence grip and forearm strengthening

• Functional and task-specific rehabilitation

• Gradual return to activities of daily living

Criteria to Progress:

• Functional range of motion

• Improving strength

• Radiographic progression of union

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

Precautions:

• Gradual return to heavier activities

• Avoid excessive loading until osteotomy union is confirmed

Therapy:

• Progressive strengthening and endurance training

• Functional rehabilitation

• Return to recreational and occupational activities

• Criteria for Return to Activity

• Radiographic union

• Functional range of motion

• Good strength and endurance

• No significant pain

General Recommendations

Work:

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

• Manual work is typically deferred until 8–12 weeks or longer depending on osteotomy 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 commence from approximately 2–4 weeks.

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

• Higher-demand wrist loading, racquet sports, or impact activities typically from 3–6 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.