Velcro Brace Discontinuation After Proximal Row Carpectomy
Velcro bracing should be discontinued immediately after proximal row carpectomy, with no initial immobilization required, allowing patients to begin rehabilitation on the day of surgery.
Evidence for Immediate Mobilization
The strongest evidence comes from a prospective cohort study demonstrating that immediate immobilization following proximal row carpectomy is unnecessary 1. This study specifically evaluated 13 patients who had no immobilization of the wrist and began rehabilitation immediately after surgery, showing that:
- At 6 weeks post-surgery, patients achieved 46-75% of passive range of motion compared to the contralateral wrist 1
- Active range of motion reached 36-46% of the non-operated side by 6 weeks 1
- Grip strength recovered to approximately 51-55% of the contralateral side within 6 weeks 1
- Early rehabilitation reduced the delay necessary to recover range of motion and strength 1
Rehabilitation Protocol Without Bracing
Begin active rehabilitation immediately on the day of surgery under supervised physical therapy guidance 1. The protocol should include:
- Immediate range of motion exercises starting postoperatively to prevent stiffness 1
- Cryotherapy application in the first postoperative week for pain control 2
- Isometric quadriceps-equivalent exercises (in this case, wrist isometrics) can be safely prescribed during the first 2 weeks 2
- Progressive strengthening as tolerated based on pain and swelling response 1
Temporary K-Wire Fixation Exception
The only scenario requiring temporary immobilization is when temporary radiocapitate K-wire fixation is used during early soft tissue healing, which may be performed in cases of chronic perilunate dislocations treated with proximal row carpectomy 3. In these specific cases, the K-wires provide internal stability, but external bracing is still not typically required.
Clinical Outcomes Supporting No Bracing
Multiple studies support motion-preserving approaches without prolonged immobilization:
- Patients achieve marked relief of wrist pain and restoration of effective wrist range of motion without extended bracing 3
- Shorter postoperative immobilization is particularly reasonable in patients requiring earlier return to work 4
- Long-term follow-up at 101 months demonstrates stable outcomes with early mobilization protocols 5
- Historical data from 24 patients followed 3-10 years showed successful outcomes with early motion, achieving 65-70% of normal extension and grip strength equal to the opposite hand 6
Critical Pitfall to Avoid
Do not routinely immobilize the wrist after proximal row carpectomy. The traditional approach of prolonged bracing delays recovery of range of motion and strength, extends time to return to work, and provides no demonstrated benefit 1, 4. Early mobilization is essential to prevent stiffness while the new radiocapitate articulation adapts 1.