Lancashire Teaching Hospitals NHS

NHS Foundation Trust

Hand Therapy Guidelines

Proximal Phalanx Fracture
ORIF & Stable / Undisplaced Fractures (base, transverse, short oblique fractures)

0-5 Days – on referral

Review initial x-ray/s
POP Back slab applied in theatre or fingers buddy taped in ED / clinic
Manufacture hand based dorsal (volar SWM) splint, extending to finger tips. MCP
joints held in approx 70˚ flexion to reduce intrinsic pull into volar angulation.
Include affected and adjacent digit – buddy strap to prevent rotation
Advise elevation for oedema management
Active flexion / extension of IP joints within splint (remove volar splint to exercise IP
joints whilst maintaining MCP flexion)

1-4 weeks
Review weekly / as required according to presentation, splint / ROM monitoring

4-6 weeks
Fracture clinic appointment – check X-ray
Check clinical signs of fracture union and review recent x-ray in hand therapy
Once clinical union confirmed commence full AROM out of splint and light function.
Continue tendon glide exercises
Consider alternative splints to promote tendon glide, blocking splints
Wean out of protective splint gradually

6 weeks
Commence graded passive ROM if required
Ongoing therapy as presentation

6-8 Weeks
Commence gentle resisted & strengthening exercises

8-12 Weeks
Gradual resume normal function
Avoid manual labour & contact sports until 12 weeks post injury

Outcome Measures
Active range of movement – affected digit
Composite grip strength measures using dynamometer
Quick DASH + Friends and Family Test.

Complications / Considerations
Fracture malunion/angulation/shortening/non-union
Wound infection following fixation
Reduced flexor/extensor tendon glide due to adherence to fracture site
Chronic oedema
Altered sensation from digital nerve compression

Updated January 2018 Review January 2020

 Lancashire Teaching Hospitals NHS
NHS Foundation Trust

Hand Therapy Guidelines

Proximal Phalanx Fracture
Unstable & Conservatively managed – Static Traction Regime
(comminuted, displaced, intra-articular with loss of joint space)

0-2 weeks
Apply skin tape traction in intrinsic plus position to reduce intrinsic deforming forces
and utilise ligamentotaxis to reduce/align fracture fragments.
Hand based splint MCP’s 70-90˚ MCP flexion, IP’s extension.

Week 1
Check splint and skin condition
Check X-ray re position if requested

2 -4 Weeks
Fracture clinic review & check X-rays as required
Traction removed & dorsal hand based splint fitted as per ORIF
Commence active mobilisation flexion/extension, tendon gliding excs within splint

4-6 weeks
Fracture clinic review & check X-ray as required
Check clinical signs of fracture union and review recent x-ray in hand therapy
Once clinical union confirmed commence full AROM out of splint and light function.
Continue tendon glide exercises
Consider alternative splints to promote flexor/extensor tendon glide, blocking splints
Wean out of protective splint gradually

6-8 Weeks
Commence graded passive ROM if required
Commence gentle resisted & strengthening exercises

8-12 Weeks
Gradual resume normal function
Avoid manual labour & contact sports until 12 weeks post injury

Outcome Measures
Active range of movement – affected digit
Composite grip strength measures using dynamometer
Quick DASH + Friends and Family Test.

Complications / Considerations
Fracture malunion/angulation/shortening/non-union
Wound infection following fixation
Reduced flexor/extensor tendon glide due to adherence to fracture site
Chronic oedema
Altered sensation from digital nerve compression

Updated January 2018 Review January 2020