As soon as possible, the patient is placed in a dynamic flexion splint with the wrist held in 30 to 45 degrees of flexion and the metacarpal phalangeal joints blocked from extending more than 45 to 60 degrees. A dorsal hood is fashioned in the splint which is straight as a reference point for the patient to judge the degree of interphalangeal extension. Traction is applied via slings or islets glued to the nails. A palmar bar is fashioned as a pulley for the traction if profundus tendons are involved in the repair. The patient is started on full active extension exercises as many times as possible during the day. They are cautioned to be on the lookout for failure to extend the proximal interphalangeal joints fully.
The wrist component of the splint is discontinued. According to the surgeon's preference, the metacarpal phalangeal block component may also be discontinued.
The splint is discontinued. The patient is started on active flexion exercises and differential gliding exercises are initiated.
Strengthening and passive extension exercises are instituted as needed. At 12 weeks the patient may return to work and unrestricted activities.
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