Replantation therapy early protected motion protocol

This protocol is applied when conditions are favorable for wound healing as an alternative to four to six weeks of complete immobilization followed by progressive mobilization.

Immobilization Phase (depending on condition of wounds)

0 - 3 weeks:

Postoperative dressing.

Early Mobilization Phase

3 weeks:

The postoperative dressing is removed.

A Resting Pan splint or individual Gutters are applied to the involved digits for a minimum of 6 weeks.

Edema control measures are initiated as needed.

Tenodesis range of motion exercises (early passive range of motion I) exercises are instituted. This consists of gentle passive wrist flexion and extension out of the splint with the patient consciously relaxing all digits. This is continued for six weeks.

Intrinsic place-and-hold (early passive motion II) are instituted two weeks postoperatively. The patient's wrist is held in neutral and they are gently passively placed into intrinsic positive and intrinsic minus positions and actively hold that position. The patient's PIP flexion is limited to less than 60 degrees until six weeks postoperatively.


When open wounds are present whirlpools may be used for debridement as needed.

Close monitoring for obstruction of venous return or arterial flow is very important. Adaptations of splints may be necessary for a winder area of contact so as not to obstruct circulation.


Instructions/precautions against excessive heat, cold, and exposure to sharp objects is essential when dealing with insensate digits.

Late Mobilization Phase

4 - 8 weeks:

Pins and Static splints are removed as fractures appear clinically healed.

Active and Passive Range of Motion and blocked flexion differential gliding exercises are initiated as indicated by bony healing.

The splinting program is modified as needed to increase Range of Motion and prevent/correct contractures.

Activities involving dexterity and coordination, with emphasis on bilateral function are helpful.

Desensitization and/or sensory re-education may be used as needed.

Job and homemaking assessments are made as indicated by each individual case. Adapted equipment may be of assistance.

8 weeks:

Gentle progressive strengthening may be initiated as long as all fractures are solid.

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