Executive Editor: Chris Colton

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

Distal phalanx Dorsal avulsion

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Aftertreatment depends on the size of the fragment, the quality of the bone, and the stability gained by the fixation.

The DIP joint is immobilized in extension in a palmar splint, leaving the PIP joint free.
PIP joint movement is encouraged immediately to avoid extensor tendon adhesion.
A Coban bandage to reduce swelling is recommended.

If the fixation is strong enough, the patient is encouraged to take off the splint 2-3 times daily, and to commence with gentle active exercises.

Functional exercises
After 3 weeks, the splint is removed, and unrestricted active flexion and extension is permitted.
Passive motion is only permitted after 4 weeks.

For ambulant patients, put the arm in a sling and elevate to heart level.
Instruct the patient to lift the hand regularly overhead, in order to mobilize the shoulder and elbow joints.
Mobilization of the PIP and MCP joints are encouraged from the very beginning.

Implant removal
The screw may need to be removed in cases of soft-tissue irritation.

v2.0 2016-06.30