Table 1 Rehabilitation protocol post-operation

Day 1–2 post-op

Advice and education

• Education regarding injury/fixation/and rehabilitation protocol- minimal axial loading

• Non-loaded ADL’s with splint off

Wound

• Remove post-operative dressing. Redress with simple dressing

Oedema

• Elevation and retrograde massage for oedema.

• Application of compression to manage oedema as required

Orthosis

• Fabrication of thermoplastic static volar wrist orthosis in extension ( ≥15 degrees), ensuring full digit flexion achievable

Exercises

Commence active wrist ROM: dart throwing axis; wrist flexion/extension/pronation/supination/radial & ulnar deviation; finger tendon gliding; thumb extension, opposition

• Commence active assist wrist extension/supination

• AROM non-affected joints of upper extremity

Day 10

• Removal of sutures

• Continue wrist orthosis

• Commence scar management: massage, desensitization and application of silicone based products

• Oedema Management as required: retrograde massage, compression, elevation

• Continue exercise program

Weeks 2–3

• Continue wrist orthosis

• Continue scar management

• Ongoing oedema management as required

• Light function in splint

• Active assisted and passive wrist exercises

• If significant difficulty achieving supination apply gentle tension rotational splint for Pronation/Supination. Commence dynamic rotational orthosis if required dependent on fracture healing, pain and oedema

• Commence stretch with 500 g weight and heat.

Weeks 4–5

• Continue wrist orthosis for at risk activities only

• Continue oedema and scar management as required.

• Active, active-assisted, passive wrist extension/flexion/pronation/supination

• Continue weighted stretches and dynamic orthotic use as required

Week 6

• Cease wrist orthosis

• Commence grip and wrist strengthening (dependant on fracture healing)

• Increase functional activity with affected hand

• Dynamic orthotic to increase range of movement

• Gradual increase in strengthening program

• Wrist proprioception exercises

Week 8 weeks +

• Continue dynamic orthotic use as required

• Continue active and passive wrist exercises

• Ongoing strengthening program

• Gradual increase with weight bearing, heavy lifting

• Function/work hardening