Guidelines metacarpal or phalangeal Fracture therapy

High risk or unstable fixation.

This refers to fractures which are not intrinsically stable and for a variety of reasons are not to be treated with fixation. These are generally treated with complete immobilization followed by aggressive remobilization.

Stable fixation/low risk.

This refers to fracture with or without skeletal fixation which are judged to be stable enough to tolerate active range of motion. These are generally treated by unrestricted active ranging early on in their course.

Rigid fixation.

These fractures are fixed in a manner which is as secure as having intact bone immediately following fixation. They are started on immediate range of motion exercises actively and passively but are not judged to be stable enough to return to unprotected sports level or heavy resistive activities until 12 weeks following repair.

In each of these situations, adjustments in the therapy schedule are based on clinical bone union which occurs when the fracture is no longer tender to direct pressure or stress.

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