Middle Phalanx (P2) PIPJ ORIF

Trauma
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Download this rehabilitation protocol (PDF)

For patients and physiotherapists.

Week 0-1

Aims:

  • Pain control
  • Protect fixation
  • Allow the wounds to heal
  • Maintain overall mobility including fingers

Suggested treatment:

  • See at 2-3/7 post op
  • Wound check and commence scar massage once wound healed
  • TPS – finger based with PIP and DIP immobilised in extension
  • AROM focusing on PIP and DIPJ flexion and extension
  • Maintain ROM of uninvolved joints

Week 1-2

Aims:

  • TPS most of the time
  • Scar massage
  • Continue AROM exercises

Suggested treatment:

  • Gradual increase range in AROM
  • Ongoing finger and elbow mobility exercises
  • Can wean out of TPS gradually

Restrictions:

  • No heavy lifting/weight bearing on repaired side
  • Lifting lighter objects (eg phone/cup) permitted

Week 3-4

Aims:

  • Wean TPS entirely during day; wear at night and risky activities
  • Continue AROM
  • Continue scar massage

Suggested treatment:

  • Progression in AROM
  • Strengthening exercises
  • Wean TPS

Restrictions:

  • No heavy lifting

Week 5 and beyond

Aims:

  • Commence PROM flexion when fracture site is non tender
  • Continue AROM exercises
  • Commence strengthening >6 weeks

Suggested treatment:

  • Commence strengthening exercises
  • No heavy lifting till 3/12 post op

Some General Questions

What to expect after surgery:

  • Most patients will be discharged after surgery (day case)
  • After you wake up, you might notice some numbness to fingers of the operated hand. This may be secondary to local anaesthetic and will wear off over 48-72 hours.
  • Mr Lau will see you prior to discharge to ensure you are safe
  • You will be sent home with medications or a script to help with pain relief

Time in Plaster:

  • You will be in a plaster (half slab) when you wake up
  • An appointment with a dedicated Hand Therapist will be arranged for ~1 week post op – they will begin early mobilisation of the hand and finger to prevent stiffness from developing, as well as customising a moulded splint to protect the fracture

Return to Activity

  • Work: Depends what you do. Desk based work can be done from 2 weeks post operatively, if you can do these tasks single handedly. Otherwise generally 6 weeks before you can use both hands freely whilst seated.
    For manual work, it depends on what kind of lifting/pushing you do, but generally not before 3 months
  • Drive: In Australia, you can’t drive unless you are in full control of both your arms. Therefore, whilst you’re in a splint, you cannot drive. Generally 6 weeks post operatively.
  • Sports/Hobbies:
    • Gentle swimming: after 6 weeks
    • Gardening (light tasks only): 8-12 weeks
    • Bowls: after 3 months
    • Golf, tennis, badminton, squash: after 4-6 months
    • Weights: commence after 3 months

Concerns or questions?

If you have any concerns post operatively, or you would like further information, please contact Mr Lau through the VBJS on 03 5752 5020 or via email at admin@vbjs.com.au

If you need urgent medical help, call 000 or go to your nearest emergency department.

These notes have been prepared by Mr Simon Lau. They are general overviews and information aimed for use by his patients. They reflect Mr Lau’s views, opinions and recommendations. They do not constitute medical advice. The contents are provided for information and education purposes only. Please seek Mr Lau’s specific advice with any questions regarding medical conditions and treatment.

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