Postoperative Immobilization After ORIF of Proximal Phalanx Fractures
At 2 weeks postoperatively following ORIF of a proximal phalanx fracture, you should transition from rigid immobilization to protected mobilization using a removable splint or buddy taping while initiating active range of motion exercises for the interphalangeal joints.
Rationale for Early Mobilization
The primary goal after stable internal fixation is to prevent finger stiffness, which is one of the most functionally disabling complications and can be extremely difficult to treat even with multiple therapy visits or additional surgery 1, 2. The evidence strongly supports that:
- Active finger motion does not adversely affect adequately stabilized fractures in terms of reduction or healing 1, 2
- Finger stiffness prevention is paramount because delayed motion significantly increases the risk of permanent functional impairment 2
- Bone healing and recovery of motion should occur simultaneously, not sequentially 3, 4
Specific Immobilization Protocol at 2 Weeks Post-ORIF
Transition to Dynamic Treatment
- Remove rigid immobilization and transition to a removable protective splint system that allows interphalangeal joint motion while protecting the fracture site 3, 4
- The splint should immobilize the metacarpophalangeal (MCP) joint in 70-90 degrees of flexion (intrinsic plus position) while allowing full active motion of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints 4
- Buddy taping to an adjacent finger is an effective alternative for stable fixations, providing protection while permitting active motion 2, 5
Active Motion Protocol
- Begin aggressive active finger motion exercises immediately for the PIP and DIP joints once the protective splint is applied 1, 2, 4
- All unaffected joints should perform active motion exercises to prevent global hand stiffness 2
- The protective splint can be removed for dressing changes, radiographic evaluations, and exercise sessions 3
Duration of Protection
- Continue protected mobilization for 3-4 additional weeks (total of 5-6 weeks from surgery) based on fracture healing progression 3, 6, 5
- Obtain radiographic follow-up at approximately 3 weeks post-surgery to confirm adequate healing before advancing mobilization 1, 2
- Transition to unrestricted motion once radiographic consolidation is confirmed, typically by 6 weeks 3, 4
Critical Pitfalls to Avoid
- Over-immobilization beyond 2 weeks leads to unnecessary stiffness and poor functional outcomes 2
- Static rigid splinting for the entire healing period results in sequential rather than simultaneous bone healing and motion recovery, which is suboptimal 3, 4
- Failure to initiate early active motion significantly increases the risk of permanent PIP joint contracture, the most common and disabling complication 1, 4
Evidence Quality Note
While the provided guidelines primarily address distal radius and Achilles tendon injuries 7, the principles of early protected mobilization after stable fixation are consistent across fracture types. The specific research on proximal phalanx fractures demonstrates excellent outcomes with dynamic treatment protocols initiated early postoperatively 3, 4, 6, 8.