This depends on the nature and level of injury , nature of internal fixation and strength of tendon repairs.. Also depends on the quality of the microsurgical anastomosis/ flow.
Our approach however is to achieve the maximal quality / strength of repair of each structure to facilitate early mobilisation. This is the same for lesser digits as well as the thumb. Having said that one of the differences with the thumb is that ROM at the IPJ / MPJ is less critical than for the MPJ/ PIPJ of lesser digits. as a consequence there is often a tendency to simplify skeletal fixation with longitudinal K-Wires often crossing the IPJ and sometimes the MPJ , which may be less desirable in lesser digits than in the thumb. Also the more complex the soft tissue injury , the more likely it is to employ simpler skeletal fixation.
However , in both Thumb and lesser digits , where possible we aim to achieve strong skeletal fixation , preferably with plate osteosynthesis that does not cross joints , and 6 strand flexor tendon repairs. This allows early active mobilisation which we commence 3 days post op as long as there have been no issues with circulation. The rehab perhaps more so for lesser digits , tends to focus a little more on active flexion than extension.
We have also recently published on our preference to position the plates on the volar surface of the bone to minimise extensor tethering and decrease occupation of space dorsally that may contribute to venous anastomosis compression - the article also discusses in greater detail our rehabilitation philosophy - the reference is
· USE OF LOW-PROFILE PALMAR INTERNAL FIXATION IN DIGITAL REPLANTATION Ross, Mark; Bollman, Christof; Couzens, Gregory B. Techniques in Hand & Upper Extremity Surgery. 19(4):147-152, December 2015
Dear Ivens Pereira
I hope to be useful
https://www.southtees.nhs.uk/content/.../MICB4742-Thumb-Extensor-Tendon-Repair..
https://www.brighamandwomens.org/.../rehabilitationservices/...Therapy...Protocols/Hand%2...
https://www.researchgate.net/topic/Knee-Arthroplasty
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