Davos Courses

Executive Editor: Chris Colton

Authors: Renato Fricker, Matej Kastelec, Fiesky Nuñez, Terry Axelrod

Thumb - Distal phalanx: Base - palmar avulsion

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Glossary

Aftertreatment

Postoperatively

While the patient is in bed, use pillows to keep the hand elevated above the level of the heart to reduce swelling.

While the patient is in bed, use pillows to keep the hand elevated above the level of the heart to reduce swelling.

Postoperative splint

A removable splint may be applied at the end of the operation, with the hand in an intrinsic plus position (“safe” or “Edinburgh” position).

A removable splint may be applied at the end of the operation, with the hand in an intrinsic plus position (“safe” or “Edinburgh” position).
Immobilize the hand in a safe position for at least 3 weeks.

Resting splint after 3 weeks

After 3 weeks, a resting splint is applied, fixing the wrist in 30 degrees of flexion, the MCP joint in 70-90 degrees of flexion, and with the PIP joint in extension.

After 3 weeks, a resting splint is applied, fixing the wrist in 30 degrees of flexion, the MCP joint in 70-90 degrees of flexion, and with the PIP joint in extension.
Every 2-3 hours, passive flexion of the PIP and the DIP is recommended in order to avoid tendon adhesion, according to the Duran method for rehabilitation of flexor tendon lacerations.

Another option is the synergistic splint with a hinge.

Follow up
See patient 5 days after surgery to check the wound, clean and change the dressing. After 10 days, remove the sutures. Check x-rays.

Functional exercises
The fixation will be vulnerable for the first 3 weeks.
After 3 weeks remove the splint and apply buddy strapping. Then begin with active motion exercises.
Instruct the patient to lift the hand regularly overhead, in order to mobilize the shoulder and elbow joints.

Implant removal
The implants may need to be removed in cases of soft-tissue irritation.
In case of joint stiffness, or tendon adhesion’s restricting finger movement, tenolysis, or arthrolysis become necessary. In these circumstances, take the opportunity to remove the implants.

v1.0 2008-11-08