Immobilization and Follow-Up Guidelines


Immobilization and Follow-Up Guidelines
Injury Splint Duration Referral
Ligamentous injuries:
Thumb MCP ulnar collateral ligament rupture      
   Partial tears Thumb spica, IP free to flex 2 wk 1 wk
   Complete or equivocal Thumb spica (presurgical repair) -- 2-3 d
Tendon injuries
Mallet finger Dorsal splint, full extension at DIP 8 wk 1 wk
Flexor tendon laceration Dorsal splint, 30-degree wrist flex, 70-degree MCP flexion, 30- to 45-degree PIP flexion (presurgical repair) -- 1 d
Dislocations:
DIP joint Dorsal splint, full extension 2 wk 1 wk
PIP joint      
 Stable/postreduction Dorsal splint, 30-degree PIP flexion 2 wk 1 wk
 Unstable/postreduction Dorsal splint, 30-degree PIP flexion 2 wk 2-3 d
MCP joint Buddy-taping 2 wk 1 wk
Carpometacarpal joint Dorsal–volar splint 2 wk 2-3 d
Thumb IP joint Dorsal splint, full extension 2 wk 1 wk
Thumb MCP joint Thumb spica 2 wk 1 wk
Fractures:
Distal phalanx Volar or hairpin splint not immobilizing PIP 2 wk 2 wk
Middle/proximal phalanx:      
 Stable/nondisplaced Buddy-taping/dynamic splinting 2 wk 1 wk
 Unstable/displaced Radial/ulnar gutter, 90-degree MCP flexion, <15- to 20-degree PIP flexion, <5- to 10-degree DIP flexion 2 wk 1 wk
Thumb proximal phalanx Thumb spica 2 wk 1 wk
Metacarpal:      
 Index, middle Radial gutter, 20-degree wrist flexion, 90-degree MCP flexion, PIP left mobile 2 wk 1 wk
 Ring, small Ulnar gutter, 20-degree wrist flexion, 90-degree MCP flexion, PIP left mobile 2 wk 1 wk
 Thumb metacarpal Thumb spica 2 wk 1 wk
 Extra-articular Thumb spica for initial immobilization (presurgical repair)    
 Intra-articular     2-3 d
Abbreviations: DIP = distal interphalangeal; IP = interphalangeal; MCP = metacarpophalangeal; PIP = proximal interphalangeal