Suture: 4.0 monofilament
Kessler with peripheral epitenon suture
2 days:
Splint: Standard Dorsal Blocking Plaster splint with wrist in full flexion minus 30° (usually 30-40°), Metacarpophalangeal joints at 90° flexion and interphalangeal joints at 0°. More recent modifications of this regime have a less extreme flexion posture.
Early Active Exercises: 2 days post-op, commence 2 hourly exercise sessions with 2 active flexion movements into air (proximal interphalangeal joints to 30° and distal interphalangeal joints to 5-10°), then 2 passive flexion movements into the palm, and 2 active extension movements back into the splint.
6 weeks:
The splint is discontinued. The patient is started on active flexion exercises and differential gliding exercises are initiated.
8 weeks:
Strengthening and passive extension exercises are instituted as needed. At 12 weeks the patient may return to work and unrestricted activities.