3 TO 4 WEEKS

Scar massage to healed wounds is initiated. Continue present exercise regimen until pins are removed from wrist. Consider appropriate edema reduction techniques such as manual and retrograde massage, light Coban wrapping.

4 TO 5 WEEKS

If bony fixation is removed from the wrist, gentle active and passive range of motion is begun. Begin FES as needed. Begin dynamic finger splinting as indicated.

5 TO 6 WEEKS

Begin composite active and passive wrist and finger motion. Begin blocking exercises to isolate joint motion. Use blocking splints as needed. Initiate pulsed ultrasound to sensate areas only if adhesions are present. Begin static volar extension pan splinting at night when indicated. Supervised light functional activities can begin.

6 TO 8 WEEKS

Discontinue use of protective splint. Continue light functional activities.

8 WEEKS

With physician approval, begin dynamic wrist splinting.

PROTOCOL IV: ARM REPLANTS-TOTAL OR SUBTOTAL

Immediately after surgery, maintain elevation of arm as directed by physician.

DAY 2 TO 7

A protective splint is frequently fabricated early because of the need for improved positioning. The elbow is splinted in postoperative position. A detachable hand splint is made with the wrist and fingers in the functional position, i.e., wrist in 0 to 30 degree extension, MPs in 45 to 65 degree flexion, IPs extended, thumb opposed (Figs. 42-17, 42-18). Wrist extension is desirable to decrease edema in the hand. Avoid tension on nerve and tendon repairs when positioning the wrist.

FIG. 42-17. Elbow splint with detachable hand splint. Dorsal view.

FIG. 42-18. Elbow splint with detachable hand splint. Palmar view.

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