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Fusión de la articulación interfalángica distal

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Se trata de un plan de recuperación protegido tras la artrodesis de la pequeña articulación de la punta del dedo más cercana a la uña: se mantiene la punta del dedo inmovilizada mediante un splint, mientras que todas las demás articulaciones permanecen móviles y se controla la hinchazón; posteriormente, una vez que el hueso se ha unido, se recupera progresivamente la capacidad de pellizcar y agarrar.

Ilustración de la articulación de la punta del dedo más cercana a la uña (la articulación DIP) fusionada en una sola unidad sólida, mantenida en una posición funcional ligeramente flexionada.
La fusión de la articulación DIP fija la pequeña articulación situada más cerca de la uña, convirtiéndola en una unidad sólida y sin dolor en una posición ligeramente flexionada; durante las primeras semanas, los huesos se unen, de modo que la articulación deja de moverse. Kieran Hirpara 4.0

Esta página se tradujo automáticamente y todavía no la ha revisado un médico. La versión en inglés es la versión oficial.

Este protocolo le servirá de guía para su recuperación tras una fusión de la articulación DIP (artrodesis), procedimiento mediante el cual se une de forma permanente la pequeña articulación situada en la punta del dedo, la más cercana a la uña, realizado por el Dr. Kieran Hirpara en el Mater Private Hospital Rockhampton. El proceso comienza con un programa de ejercicios para realizar en casa; posteriormente, siga el protocolo clínico estructurado redactado para su terapeuta de mano: lleve esta página o su versión en PDF a su primera sesión de terapia para garantizar que la rehabilitación se lleve a cabo de manera coordinada. Su terapeuta podrá modificar el plan según la evolución de su recuperación.

Si tiene alguna duda o inquietud respecto a la herida quirúrgica, no dude en ponerse en contacto con el consultorio. A menudo resulta útil tomar una fotografía de la herida y enviarla por correo electrónico para su revisión.

Qué esperar

La fusión de la articulación DIP se realiza cuando la pequeña articulación más cercana a la uña está deteriorada y dolorosa, generalmente a causa de artritis (las protuberancias óseas llamadas nódulos de Heberden), o para extirpar un quiste mucoso problemático junto con el espolón óseo subyacente. En lugar de intentar mantener en movimiento una articulación dañada y dolorosa, la operación la fusiona de forma sólida en una posición ligeramente flexionada y funcional (hasta unos 35°). Por diseño, esa articulación ya no se mueve nunca, y a cambio desaparece el dolor y la punta del dedo queda estable y fuerte para realizar pinzas. La fijación suele hacerse con un pequeño tornillo sin cabeza implantado bajo la piel que permanece allí para siempre (no es necesario extraerlo); en ocasiones se usa un alambre K, que se retira alrededor de las seis semanas. Si se extirpó un quiste mucoso, también deberá cuidar la piel o el pliegue ungueal mientras esa zona cicatriza.

Toda su rehabilitación se basa en una idea sencilla: proteger la fusión hasta que el hueso se una, pero mantener en movimiento todo lo demás. Por lo general, el hueso queda unido al cabo de seis a ocho semanas, y las radiografías lo confirman alrededor de las diez semanas. Hasta entonces:

  • La punta del dedo fusionada se inmoviliza y protege para no alterar la consolidación ósea.
  • Todas las demás articulaciones siguen moviéndose: la articulación media del dedo, la articulación metacarpofalángica, el pulgar, la muñeca y todos los demás dedos, para evitar que la mano se vuelva rígida.
  • Se controla la hinchazón y se cuida la cicatriz para que el dedo permanezca cómodo y flexible.
  • Una vez que el hueso se ha unido, la capacidad de hacer pinzas y agarrar se recupera de forma gradual, no de golpe.

Precauciones y limitaciones

  • Use la férula para la punta del dedo según las indicaciones. Al principio se usa de forma continua; posteriormente, solo durante las actividades. Mantiene inmóvil la articulación fusionada, pero permite que la articulación intermedia del dedo (la PIP) se mueva libremente.
  • NO haga agarres fuertes, no apriete con fuerza ni levante cargas pesadas con el dedo operado hasta que la fusión sea completa y el médico lo autorice; durante las primeras seis semanas, limítese a cargas de aproximadamente 1 kg (≈2 lb).
  • Mueva todas las demás articulaciones desde el inicio: la articulación intermedia y las articulaciones interfalángicas del dedo, el pulgar, la muñeca y todos los demás dedos.
  • Mantenga el vendaje seco y la mano elevada durante los primeros 10–14 días para reducir la hinchazón; siga también las indicaciones de cuidado del pliegue ungueal o del sitio donde se extirpó el quiste mucoso, si aplica.
  • Si tiene un clavo K, protéjalo y mantenga la zona limpia hasta su extracción, que se realiza alrededor de las seis semanas; el tornillo implantado no requiere extracción.
  • NO conduzca hasta que haya retirado la férula voluminosa y pueda agarrar y controlar el volante con seguridad; generalmente esto ocurre alrededor de las seis semanas, según criterio de su cirujano.

Para el cuidado de la herida, la hinchazón y las cicatrices, consulte las pautas de cuidado de heridas de nuestra consulta.

Sus ejercicios

Estos son los ejercicios que aparecen en su folleto informativo. Comience a realizarlos únicamente bajo la guía del Dr. Hirpara y de su terapeuta de mano, respetando todos los límites que se le hayan indicado. Los ejercicios iniciales tienen como objetivo mantener el resto de la mano en movimiento libre sin afectar la falange fusionada: movimiento de las articulaciones situadas a ambos lados de la fusión, de todos los demás dedos, del pulgar y de la muñeca; deslizamientos tendinosos y control de la hinchazón. El fortalecimiento de la prensión y el pellizco corresponden a una fase posterior, por lo que no debe iniciarse hasta que la fusión sea visible en la radiografía y se le haya dado autorización expresa. Interrumpa cualquier ejercicio que provoque dolor intenso en la punta del dedo.

Su protocolo clínico

El resto de esta página describe el protocolo clínico por fases para la rehabilitación tras una artrodesis de la articulación DIP (articulación interfalángica distal). Esta sección debe entregarse a su terapeuta de mano; cada fase comienza con una explicación sencilla en lenguaje coloquial sobre lo que se está haciendo. El principio fundamental es proteger el sitio de la artrodesis hasta lograr la unión ósea, manteniendo al mismo tiempo movilidad completa en todas las demás articulaciones: la articulación DIP se inmoviliza mediante una férula P2–P3 que deja libre la articulación PIP; se controla el edema y la cicatrización, y la fuerza de pinza y agarre se va reintroduciendo progresivamente solo tras la consolidación ósea.

Antes de iniciar el tratamiento, revise el informe quirúrgico del paciente y su historial médico; además, consulte con el cirujano responsable sobre el tipo de fijación utilizada (tornillo de compresión sin cabeza, no extraíble, o aguja K, extraída aproximadamente a las 6 semanas), la posición de fusión ósea (ligera flexión, hasta unos 35°) y si se realizó resección de un quiste mucoso junto con escisión de piel y pliegue ungueal. Por lo general, la consolidación clínica se observa alrededor de 6–8 semanas, mientras que la consolidación radiográfica ocurre aproximadamente a las 10 semanas. El cronograma de rehabilitación que se detalla a continuación representa un consenso experto preliminar; su aplicación queda a criterio del cirujano y debe confirmarse mediante radiografías antes de retirar la férula y comenzar la carga funcional.

Fase 1 — protección y estabilización (semanas 0 a 2)

Durante estas dos primeras semanas se protege la fusión recién realizada y se controla la hinchazón y la cicatrización, al tiempo que se mantienen en movimiento todas las articulaciones no afectadas para evitar cualquier rigidez.

Para su terapeuta de mano:

Educación y precauciones - Vendaje quirúrgico grueso o férula con elevación durante los primeros 10–14 días; mantenga el vendaje seco - Proteja el sitio de la artrodesis; no se debe aplicar carga sobre la yema del dedo operado - Si hay un alambre K en el sitio, proteja el punto de inserción; revise también la herida resultante de la excisión de quistes o pliegues ungueales, si procede

Manejo - Herida: utilice los vendajes quirúrgicos según indicaciones; vigile signos de infección - Edema: mantenga elevación, realice movimientos suaves de bombeo con la mano y aplique hielo según sea necesario - Ejercicios: realice movimientos activos de amplitud completa en todas las articulaciones no afectadas: articulaciones PIP y MCP del dedo operado, pulgar, muñeca y demás dedos; inicie los deslizamientos tendinosos cuando el paciente lo tolere

Criterios para avanzar - La herida se ha estabilizado; la hinchazón está controlada; listo para pasar a una férula personalizada y desmontable que bloquee la articulación DIP alrededor de las dos semanas

Fase 2 — Férula removible para bloqueo de la articulación DIP con actividad (semanas 2 a 6)

A partir de la segunda semana, el vendaje voluminoso se sustituye por una férula removible personalizada para bloqueo de la articulación DIP (una órtesis tipo Stax/mallet que abarca desde P2 hasta P3), la cual inmoviliza únicamente la articulación distal de los dedos y deja libre la articulación PIP. Durante esta fase, debe llevarse continuamente. Se fomenta el movimiento activo en todas las demás articulaciones; se controla la hinchazón y la cicatrización, y la punta del dedo permanece sin carga.

Para su terapeuta de mano:

Instrucciones y precauciones - Férula removible personalizada para bloqueo de la articulación DIP (P2–P3, PIP libre) que debe llevarse continuamente durante esta fase - Prohibido realizar agarres fuertes o pinzas; el límite de carga funcional es de aproximadamente 2 lb (≈1 kg)

Manejo - Ejercicios: movilización activa de las articulaciones PIP, MCP, pulgar y muñeca, así como de todos los demás dedos; deslizamientos tendinosos (posición de gancho, puño cerrado, mano extendida) - Hinchazón: mantener la elevación de la mano y añadir compresión (vendaje Coban o manga ligera) según tolerancia - Cicatriz: iniciar masaje cicatricial una vez que la herida haya cicatrizado por completo; cuidado de los pliegues ungueales en zonas donde se extirpó un quiste mucoso

Criterios para avanzar a la siguiente fase - Mantenimiento del rango de movimiento en articulaciones PIP/MCP; hinchazón controlada; herida completamente cicatrizada; se observa consolidación ósea alrededor de la semana seis (solo se procederá a retirar la férula tras confirmación radiológica de la consolidación)

Fase 3 — retirar progresivamente el splint y comenzar el fortalecimiento suave (semanas 6 a 8)

Una vez que la fusión ósea se haya confirmado en la radiografía (clínicamente, alrededor de 6–8 semanas), se retira progresivamente el splint (solo se usa durante actividades o para protección), y el alambre K, si se utilizó, se retira aproximadamente a las seis semanas. Entonces se inicia el fortalecimiento suave de la pinza y la prensión.

Para su terapeuta de mano:

Educación y precauciones - Retirar progresivamente el splint en la articulación DIP una vez confirmada la fusión: seguir usándolo únicamente para protección o durante actividades según sea necesario; el alambre K se retira alrededor de la semana 6 - Aumentar la carga de forma gradual; el límite funcional es de aproximadamente 5 lb (≈2 kg) a partir de la semana 8

Manejo - Ejercicios: iniciar fortalecimiento suave de la prensión y la pinza: uso de plastilina terapéutica, ejercicios ligeros de pinza y prensión; mantener el rango completo de movimiento en todas las demás articulaciones; continuar el cuidado de la cicatriz - Revaluar cualquier hinchazón residual o rigidez en las articulaciones PIP/MCP y tratar según sea necesario

Criterios para avanzar - Confirmación radiográfica de la fusión; punta del dedo sin molestias; tolerancia al aumento gradual de carga sin dolor en el sitio de fusión

Fase 4 — fortalecimiento progresivo y alta del tratamiento (semanas 8 a 12)

Una vez consolidada la fusión, se procede al fortalecimiento para recuperar la función normal de la mano; alrededor de la semana 12 se levantan todas las restricciones.

Para su terapeuta de mano:

Educación y precauciones - Fortalecimiento progresivo de la prensión y el pellizco; límite funcional aproximado de 10 lb (≈4,5 kg) alrededor de la semana 10 - Sin restricciones a partir de la semana 12, sujeto a revisión por parte del cirujano

Manejo - Ejercicios: prensión y pellizco resistivos de forma gradual (desde plastilina hasta pinzas y cargas específicas para tareas); objetivo: recuperar el uso funcional completo de la mano - Considere el alta del tratamiento cuando se logre una punta digital estable y sin dolor, además de una función y fuerza de la mano casi normales - Derive nuevamente al cirujano tratante si aparece dolor en la zona de la fusión, hay dudas sobre la consolidación ósea o el resultado funcional resulta insatisfactorio

Criterios para el alta - Fusión ósea consolidada y sin dolor; movilidad completa en todas las articulaciones no fusionadas; recuperación de la capacidad de pellizco y prensión funcionales

Volver al trabajo y a las actividades cotidianas

Se recomienda, desde el principio y dentro de lo que resulte cómodo, el uso moderado de los demás dedos y del resto de la mano; únicamente se debe evitar mover la punta del dedo que ha sido fusionada. Por lo general, se puede conducir al cabo de unas seis semanas, una vez retirado el grueso yeso y cuando el paciente pueda agarrar y controlar el volante de forma segura; esta decisión queda a criterio del Dr. Hirpara durante la revisión médica, por lo que deberá planificar contar con ayuda para el transporte durante las primeras semanas. Los movimientos de pinzamiento y agarre suave suelen iniciarse alrededor de las seis semanas y se intensifican a partir de las ocho semanas, una vez que el hueso se haya soldado. El uso completo, intenso o para actividades deportivas de la mano suele alcanzarse alrededor de las doce semanas. Estos plazos son guías basadas en el consenso de expertos, no fechas límite fijas: la valoración de su cirujano y los resultados de la radiografía (que confirman la soldadura ósea) son los factores determinantes.

Después de seguir este protocolo

Este protocolo se complementa con las recomendaciones generales de recuperación del consultorio; consulte también control del dolor postoperatorio, cuidado de la herida y manejo de las cicatrices. El plan por fases descrito anteriormente se basa en las guías de rehabilitación publicadas tras una artrodesis de la articulación DIP; su recuperación continua será supervisada individualmente por el Dr. Hirpara y su terapeuta de mano, según la evolución de la curación de su dedo.

Reviewed by Dr Kieran Hirpara · 20 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

DIP Joint Fusion — Procedure Outcomes & Post-operative Rehabilitation (Distal Interphalangeal Arthrodesis)

Topic scope: post-operative rehabilitation after arthrodesis (fusion) of the distal interphalangeal (DIP) joint — most often for end-stage osteoarthritis (Heberden's nodes), or to excise a mucous cyst together with its underlying osteophyte. This is a fusion, not a reconstruction: the joint is deliberately and permanently abolished and set in a slightly flexed, functional position, so the rehabilitation is a protect-to-union pathway built around oedema control, scar/nail-fold management, and preservation of motion at every adjacent joint, followed by progressive reloading — not restoration of DIP motion.

Defining principle of the rehab here: a DIP arthrodesis is meant to stop moving. The single therapeutic goal is to deliver a solid, pain-free, well-aligned bony union while keeping the rest of the hand fully mobile. The fingertip is immobilised in a P2–P3 (Stax/mallet-type) orthosis that blocks the DIP but leaves the PIP free; the deliberate restraints are protection of the fixation and avoidance of pinch/grip loading until union. The principal branch points are the fixation method (buried headless compression screw — no removal — versus K-wire, removed at ~6 weeks) and whether a mucous cyst with skin/nail-fold excision was performed, which adds soft-tissue/scar care. Union, not the calendar, gates splint weaning and loading.

A. PROCEDURE OUTCOMES (fusion union, position, fixation)

DIP arthrodesis is a reliable pain-relieving operation; the principal technical debates are over fixation method and fusion position, not whether to fuse a painful, end-stage joint.

  • High union rates with headless compression screw fixation. A series of 64 joints fused with a Herbert-type headless compression screw reported reliable bony union with a low complication profile, supporting the buried-screw construct that requires no later removal [Hand 2010, DOI: 10.1007/s11552-010-9295-3]. Moderate (observational case series).
  • Radiographic union averages around ten weeks. A review of DIP arthrodesis techniques reports a mean time to radiographic fusion of approximately 10 weeks, with reported union rates such as ~85% in the Brutus cohort, underlining that clinical comfort precedes full radiographic consolidation [J Hand Surg Am 2013, DOI: 10.1016/j.jhsa.2013.06.010]. Moderate (review of case series).
  • Fusion position is a consensus, not a controversy. Technique descriptions place the DIP in slight flexion in a functional position for pinch; dorsal-plate and screw techniques are described with attention to setting and holding this position during fixation [J Hand Surg Am 2018, DOI: 10.1016/j.jhsa.2018.03.049]. Mechanistic / consensus.
  • Screw fit depends on bony dimensions. Anatomical sizing work shows the headless screw must be matched to the medullary dimensions of the distal phalanx, informing implant selection and reducing fixation-related complications [Hand 2014, DOI: 10.1007/s11552-014-9679-x]. Mechanistic.
  • Fixation choice carries differing complication patterns. Comparative data on K-wire versus headless (Herbert) screw fixation describe differences in infection and hardware-related events, relevant to the protective pin care needed when a K-wire is used and removed at ~6 weeks [J Hand Surg Am 2013, DOI: 10.1016/j.jhsa.2013.01.017]. Moderate (comparative series).
  • Acute arthrodesis is an established option in trauma. Primary IP-joint arthrodesis for acute injury is a recognised technique, supporting fusion as a durable solution beyond degenerative disease [J Hand Surg / Thieme 2017, DOI: 10.1055/s-0037-1608691]. Moderate (case series).

B. REHABILITATION / THERAPY EVIDENCE

There are no randomised trials of rehabilitation after DIP arthrodesis. The rehab pathway is built from surgical-outcome timing data (union ~6–8 weeks clinical, ~10 weeks radiographic) plus published hand-therapy protocols and standard hand-therapy practice. The therapeutic logic is to immobilise only the fused joint, keep every other joint moving, control swelling and scar, and reload pinch/grip only after union.

  • Immobilise the DIP, free the PIP. Published finger-fusion therapy protocols use a custom removable DIP-blocking (Stax/mallet-type) orthosis spanning P2–P3 that holds the fingertip joint while leaving the PIP free for active motion — continual early wear, weaning to activity-only after X-ray union [TCO; Hand Wisconsin; Alaska Ortho; Melbourne Arm Clinic protocols, URLs below]. Weak (consensus / published protocols).
  • Preserve motion at all uninvolved joints from day one. Active motion of the PIP, MCP, thumb, wrist and all other digits, plus tendon glides, is standard hand-therapy practice to prevent stiffness while the DIP consolidates [published protocols, URLs below]. Consensus / standard practice.
  • Oedema and scar control are routine adjuncts. Elevation and compression for swelling, and scar massage once healed (with nail-fold care after mucous-cyst excision), follow standard hand-therapy practice rather than trial evidence. Consensus / standard practice.
  • Loading is gated by union, not by date. Protocols withhold power grasp/pinch until the fusion is radiographically united, then progress strengthening gradually — reflecting the ~10-week mean radiographic union from the outcome literature [J Hand Surg Am 2013, DOI: 10.1016/j.jhsa.2013.06.010]. Weak–moderate (timing anchored to outcome series; rehab schedule consensus).

Recovery trajectory (expected, evidence-anchored)

Phase Window Restraint Hand use / therapy focus Strength / load Notes
1 — Protect & settle Week 0–2 Bulky dressing/splint; DIP unloaded Elevation; AROM of all uninvolved joints (PIP, MCP, thumb, wrist, other digits); begin tendon glides None to the fingertip Keep dressing dry; review pin/cyst-excision wound
2 — DIP-blocking splint with activity Week 2–6 Custom P2–P3 DIP-block, PIP free, worn continually Active PIP/MCP/thumb/wrist + all-other-digit motion; tendon glides; oedema (Coban/sleeve); scar massage once healed No power grasp/pinch; ~2 lb (≈1 kg) limit Clinical union emerging ~6 wk
3 — Wean splint & gentle strengthening Week 6–8 Splint weaned once united on X-ray; K-wire out ~6 wk Begin gentle grip/pinch (putty, light pinch/grip); continue full motion elsewhere; continue scar care ~5 lb (≈2 kg) from 8 wk Buried screw needs no removal
4 — Progressive strengthening & discharge Week 8–12 Restrictions lifting Progressive grip/pinch strengthening; restore full hand use ~10 lb (≈4.5 kg) at 10 wk; no restriction ~12 wk Discharge when fusion solid + pain-free

(Phase windows mirror the precautions and recovery-curve structure in the patient protocol; clinical union ~6–8 weeks and radiographic union ~10 weeks are anchored to the outcome series, while the exact phase timings are low-level expert consensus, not trial-derived deadlines, and are subject to surgeon discretion and X-ray confirmation of union.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Fixation method. Buried headless compression screw (no removal) versus K-wire (removed ~6 weeks) — both achieve union; the comparative literature describes differing infection and hardware-event profiles, and the choice drives whether pin-site protection is needed in rehab [DOI: 10.1007/s11552-010-9295-3; DOI: 10.1016/j.jhsa.2013.01.017]. Moderate.
  2. Fusion position. Slight flexion (up to ~35°) in a functional pinch position is a settled consensus across technique descriptions, not a live controversy [DOI: 10.1016/j.jhsa.2018.03.049]. Consensus.
  3. Union timing. Clinical comfort (~6–8 weeks) precedes radiographic union (~10 weeks mean), so splint weaning and loading should follow the X-ray rather than the calendar [DOI: 10.1016/j.jhsa.2013.06.010]. Moderate.
  4. Rehabilitation schedule. No RCTs exist for DIP-fusion rehab; phase timings are derived from published therapy protocols and standard hand-therapy practice anchored to surgical union data. Low-level expert consensus.
  5. Mucous-cyst cases. Excision of a mucous cyst with its osteophyte adds skin/nail-fold and scar care to the standard fusion rehab; this is a soft-tissue management addition rather than a change to the bony-union pathway. Consensus / standard practice.

D. EVIDENCE STRENGTH FLAGS (summary)

  • MODERATE (observational case series / reviews): reliable bony union with headless compression screw fixation; mean radiographic union ~10 weeks (~85% union, Brutus); differing complication profiles by fixation method; acute IP arthrodesis as an established trauma option.
  • CONSENSUS / MECHANISTIC: slight-flexion functional fusion position; screw sizing to phalangeal dimensions; immobilise-the-DIP / free-the-PIP splinting principle.
  • WEAK / LOW-LEVEL CONSENSUS: the specific phased rehabilitation schedule (no RCTs; derived from published therapy protocols + standard hand-therapy practice, anchored to union timing); exact phase timings and load limits (typical guides, not trial-derived); oedema/scar adjuncts (standard practice).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Distal interphalangeal joint arthrodesis using a dorsal plate: technique and fusion position. J Hand Surg Am. 2018. DOI: 10.1016/j.jhsa.2018.03.049
  • Distal interphalangeal joint arthrodesis with the Herbert headless compression screw: union and complications in 64 joints. Hand (N Y). 2010. DOI: 10.1007/s11552-010-9295-3
  • Distal interphalangeal joint arthrodesis: review of techniques and outcomes (mean ~10-week radiographic fusion; Brutus ~85% union). J Hand Surg Am. 2013. DOI: 10.1016/j.jhsa.2013.06.010
  • K-wire versus Herbert screw fixation for distal interphalangeal joint arthrodesis: infection and hardware events. J Hand Surg Am. 2013. DOI: 10.1016/j.jhsa.2013.01.017
  • Anatomical sizing of headless compression screws for distal phalangeal fixation. Hand (N Y). 2014. DOI: 10.1007/s11552-014-9679-x
  • Acute interphalangeal joint arthrodesis in trauma. J Hand Surg / Thieme. 2017. DOI: 10.1055/s-0037-1608691

DIP-fusion rehabilitation literature (URLs)

  • Twin Cities Orthopedics — Distal Interphalangeal (DIP) Joint Fusion post-op protocol. https://www.tcomn.com/wp-content/uploads/2016/06/Distal-Interphalangeal-DIP-Joint-Fusion.pdf
  • Hand Wisconsin — Finger-joint fusion therapy protocol. https://handwisconsin.com/wp-content/uploads/2016/09/fusion-finger-joint-therapy-protocol.pdf
  • Alaska Orthopaedics — Arthrodesis (DIP / PIP or MCP) joint fusion protocol. https://www.akortho.com/wp-content/uploads/Arthrodesis-DIP-PIP-or-MCP-Joint-Fusion.pdf
  • Melbourne Arm Clinic — PIP / DIP arthrodesis rehabilitation protocol. https://melbournearmclinic.com.au/orthopaedic-rehabilitation/shoulder-rehabilitation/pip-dip-arthrodesis-protocol/

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Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.