Skip to content

Patients › Rehabilitation

Pagsasama ng DIP Joint

PDF Evidence

Isang protektadong plano ng paggaling pagkatapos ng pagsasama (arthrodesis) ng pinakamaliit na kasukasuan ng dulo ng daliri na nasa tabi ng kuko, pagpapanatili ng splint sa dulo ng daliri habang ang bawat ibang kasukasayan ay nananatiling gumagalaw at kontrolado ang pamamaga, at pag-unlad ng pagkukumpas at hawak kapag ang buto ay nagsama na.

Illustrasyon ng kasukasuan ng dulo ng daliri na pinakamalapit sa kuko (ang DIP joint) na pinagsama sa isang solidong yunit, nakalock sa bahagyang baluktot na posisyon na functional.
Ang DIP joint fusion ay naglulock ng maliit na kasukasuan na nasa pinakamalapit sa kuko sa isang matibay, walang sakit na yunit sa bahagyang baluktot na posisyon; ang mga buto ay magkakasama sa loob ng unang linggo, kaya hindi na gumagalaw ang kasukasuan. Kieran Hirpara 4.0

Ang pahinang ito ay isinalin ng makina at hindi pa nasusuri ng isang doktor. Ang bersyong Ingles ang siyang opisyal.

Ang protocol na ito ay gabay sa iyong paggaling pagkatapos ng pagsasama ng DIP joint (arthrodesis), kung saan permanenteng pinagsasama ang maliit na kasukasuan sa dulo ng iyong daliri, malapit sa kuko, kasama si Dr Kieran Hirpara sa Mater Private Hospital Rockhampton. Nagsisimula ito sa iyong home exercise program, sinundan ng istrukturadong klinikal na protocol na isinulat para sa iyong hand therapist: dalhin ang pahinang ito o ang PDF nito sa iyong unang bisita sa therapy upang manatiling koordinado ang iyong rehabilitasyon. Maaaring baguhin ng iyong therapist ang plano depende sa pag-unlad ng iyong paggaling.

Kung mayroon kang anumang alalahanin tungkol sa iyong sugat pagkatapos ng operasyon, makipag-ugnayan sa mga kwarto. Karaniwang makakatulong na kumuha ng litrato ng sugat at ipadala ito sa pamamagitan ng email para sa pagsusuri.

Ano ang inaasahan

Ang DIP joint fusion ay ginagawa kapag ang maliit na kasukasuan na pinakamalapit sa kuko ay nasira at masakit, kadalasan dahil sa arthritis (mga butong pagbubulok na tinatawag na Heberden's nodes), o upang alisin ang isang mapanganib na mucous cyst kasama ang bone spur sa ilalim nito. Sa halip na subukang panatilihin ang galaw ng isang masakit at sira na kasukasuan, ang operasyon ay pinagsasama ito nang matibay sa bahagyang liko, functional na posisyon (hanggang humigit-kumulang 35°). Ayon sa disenyo, hindi na kumikilos ang kasukasuang iyon, at bilang kapalit, nawawala ang sakit at nagiging matatag at malakas ang dulo ng daliri para humawak. Karaniwang ginagamit ang isang maliit na buried headless screw na nananatili sa loob nang habambuhay (walang kailangang alisin), o minsan ay isang K-wire na inaalis sa loob ng humigit-kumulang anim na linggo. Kung alisin ang isang mucous cyst, kailangan din mong mag-ingat sa balat o nail-fold habang gumagaling ang lugar.

Ang buong rehabilitation ay nakabase sa isang simpleng ideya: protektahan ang fusion hanggang sa magkasama ang buto, ngunit panatilihin ang galaw ng lahat ng iba. Karaniwang nararamdaman na magkasama ang buto sa loob ng anim hanggang walong linggo, at nakikita sa X-ray sa loob ng humigit-kumulang sampung linggo. Hanggang noon:

  • Ang pinagsamang dulo ng daliri ay may splint at protektado upang hindi maabala ang gumagaling na buto.
  • Ang lahat ng ibang kasukasuan ay nananatiling gumagalaw: ang gitnang kasukasuan ng daliri, ang knuckle, ang hinlalaki, ang pulso, at lahat ng iyong ibang daliri, upang hindi maging matigas ang kamay.
  • Nakokontrol ang pamamaga at pinamamahalaan ang peklat upang manatiling komportable at malambot ang daliri.
  • Kapag nagkasama na ang buto, hinahati-hati at dahan-dahang binubuo ang pinch at grip sa halip na sabay-sabay.

Mga Precautions at Limitasyon

  • Suotin ang fingertip splint ayon sa utos. Sa unang yugto, ito ay suot nang patuloy; sa huli, ito ay suot lamang kapag gumagawa ng gawain. Ito ay nagpapanatili ng katigasan ng pinagsamang kasukasuan ngunit pinapayagan ang gitnang kasukasuan ng daliri (ang PIP) na gumalaw.
  • HUWAG mag-power-grip, mahigpit na mag-pinches, o mag-angat ng mabigat gamit ang operadong daliri hangga't hindi pa natutugma ang pagsasama ng kasukasuan at hindi pa ka pinapayagan; manatili sa humigit-kumulang 1 kg (≈2 lb) sa unang anim na linggo.
  • Panatilihing gumagalaw ang lahat ng ibang kasukasuan mula sa simula: ang gitnang kasukasuan at knuckle joints ng daliri, ang hinlalaki, ang pulso, at ang lahat ng iyong ibang mga daliri.
  • Panatilihing tuyo ang dressing at itaas ang kamay sa unang 10–14 araw upang bawasan ang pamamaga, at sundin ang anumang alaga sa nail-fold o cyst-site kung inalis ang mucous cyst.
  • Kung mayroon kang K-wire, protektahan ito at panatilihing malinis ang lugar hangga't ito ay inalis sa humigit-kumulang anim na linggo; ang buried screw ay hindi na kailangang alisin.
  • HUWAG magmaneho hangga't wala ka pa sa bulky splint at hindi ka pa nakakapag-grip at kontrolin ang manibela nang ligtas, karaniwan sa humigit-kumulang anim na linggo, sa pagpapatunay ng iyong doktor.

Para sa pangangalaga sa sugat, pamamaga, at peklat, tingnan ang gabay ng klinika tungkol sa wound care.

Ang iyong mga ehersisyo

Ito ang mga ehersisyo mula sa iyong handout. Simulan lamang ito ayon sa gabay ni Dr. Hirpara at ng iyong hand therapist, at manatili sa loob ng anumang limitasyon na ibinigay sa iyo. Ang mga maagang ehersisyo ay pinapanatili ang malayang paggalaw ng natitirang bahagi ng kamay hindi pinagkakait ang pinagsamang dulo ng daliri: paggalaw ng mga kasukasuan sa magkabilang panig ng pinagsamang bahagi, lahat ng iyong ibang daliri, hinlalaki, at pulso, tendon glides, at kontrol sa pamamaga. Ang pagpapalakas ng hawak at pinch ay nasa huling yugto at hindi dapat simulan hanggang sa mag-union ang pinagsamang bahagi sa X-ray at ikaw ay partikular na pinapayagan. Itigil ang anumang nagdudulot ng matulis na sakit sa dulo ng daliri.

Ang iyong klinikal na protokol

Ang natitirang bahagi ng pahinang ito ay ang yugto-yugto na klinikal na protokol para sa rehabilitasyon pagkatapos ng arthrodesis ng DIP joint (distal interphalangeal). Ang seksyong ito ay dapat ibigay sa iyong hand therapist, at ang bawat yugto ay nagsisimula sa isang paliwanag sa simpleng wikang Ingles kung ano ang nangyayari. Ang prinsipyo ay protektahan ang arthrodesis site hanggang sa maging bony union habang pinapanatili ang buong galaw sa bawat ibang joint: ang DIP ay immobilised sa isang P2–P3 splint na nag-iwan ng PIP na malaya, ang oedema at scar ay pinamamahalaan, at ang pinch/grip ay binabagay nang unti-unti lamang pagkatapos ng union.

Bago ang paggamot, suriin ang operation report at past medical history ng pasyente, at makipag-ugnayan sa treating surgeon tungkol sa fixation (headless compression screw, buried, walang pag-alis, vs K-wire, inalis ~6 linggo), ang posisyon ng fusion (bahagyang flexion, hanggang ~35°), at kung isinagawa ang mucous cyst na may skin/nail-fold excision. Ang clinical union ay karaniwang inaasahan sa loob ng 6–8 linggo habang ang radiographic union ay nasa loob ng 10 linggo; ang rehab timeline sa ibaba ay low-level expert consensus at nakadepende sa discretion ng surgeon at X-ray confirmation ng union bago ang splint weaning at loading.

Yugto 1 — protektahan at ayusin (linggo 0 hanggang 2)

Ang unang dalawang linggo ay nagpoprotekta sa bagong pinagsamang kasukasuan, nagpapababa ng pamamaga at nagpapagaling sa sugat, habang pinapanatiling gumagalaw ang lahat ng hindi apektadong kasukasuan upang hindi ito mahigpit.

Para sa iyong hand therapist:

Edukasyon at mga paalala - Makapal na surgical dressing/splint na may elevation sa unang 10–14 araw; panatilihing tuyo ang dressing - Protektahan ang lugar ng arthrodesis; walang pagbebenta sa dulo ng hinirap na daliri - Kung mayroong K-wire, protektahan ang pin site; suriin ang sugat sa nail-fold/cyst-excision kung kinakailangan

Pamamahala - Sugat: surgical dressings ayon sa utos; monitor para sa impeksyon - Pamamaga: elevation, banayad na pagpump ng kamay, ice kung angkop - Mga ehersisyo: AROM ng lahat ng hindi apektadong kasukasuan: PIP at MCP ng hinirap na daliri, hinirap na hinirap, pulso, at lahat ng ibang daliri; simulan ang tendon glides kung kinakailangan

Mga pamantayan para magpatuloy - Pagpapagaling ng sugat; kontrolado ang pamamaga; handa na para lumipat sa custom removable DIP-blocking splint sa humigit-kumulang dalawang linggo

Yugto 2 — DIP-blocking splint kasama ang aktibidad (linggo 2 hanggang 6)

Mula sa humigit-kumulang dalawang linggo, ang makapal na panapos ay palitan ng custom na removable na DIP-blocking splint (isang uri ng orthosis na Stax/mallet na sumasaklaw sa P2–P3) na nag-iimmobilisa lamang sa kasukasuan ng dulo ng daliri at pinapalaya ang PIP. Itong splint ay suot nang tuloy-tuloy sa yugtong ito. Ang buong aktibong galaw ay inirerekomenda sa ibang bahagi, ang pamamaga at peklat ay pinamamahalaan, at ang dulo ng daliri ay nananatiling walang bigat.

Para sa iyong hand therapist:

Edukasyon at mga paalala - Custom na removable na DIP-blocking splint (P2–P3, PIP free) na suot nang tuloy-tuloy sa yugtong ito - Walang power grasp o pinch; limitasyon sa functional load ~2 lb (≈1 kg)

Pamamahala - Mga ehersisyo: aktibong PIP, MCP, hinlalaki at wrist na galaw kasama ang lahat ng ibang daliri; tendon glides (hook, buong pako, tuwid) - Pamamaga: patuloy na pagtaas ng kamay at pagdagdag ng compression (Coban/magaan na sleeve) kung tolerado - Peklat: simulan ang pagmamasahe sa peklat kapag buo nang nakagaling ang sugat; alagaan ang nail-fold kung may excised na mucous cyst

Mga pamantayan para mag-proceed - Panatilihin ang galaw ng PIP/MCP; kontroladong pamamaga; nakagaling na sugat; klinikal na union na lumalabas sa humigit-kumulang anim na linggo (mag-proceed sa pag-wean lamang kung may X-ray na kumpirmasyon ng union)

Yugto 3 — unti-unting bawasan ang paggamit ng splint at simulan ang banayad na pagpapalakas (linggo 6 hanggang 8)

Kapag nag-union na ang fusion sa X-ray (klinikal na ~6–8 linggo), unti-unting babawasan ang paggamit ng splint (isusuot lamang para sa aktibidad/proteksyon) at tatanggalin ang K-wire, kung ginamit, sa humigit-kumulang anim na linggo. Simulan ang banayad na pagpapalakas ng pinch at grip.

Para sa iyong hand therapist:

Edukasyon at mga paalala - Unti-unting bawasan ang paggamit ng DIP splint kapag kumpirmado ang union: patuloy na paggamit para sa proteksyon/aktibidad lamang kung kinakailangan; tatanggalin ang K-wire ~6 linggo - Unti-unting dagdagan ang pag-load; functional limit na ~5 lb (≈2 kg) mula sa humigit-kumulang 8 linggo

Pamamahala - Mga ehersisyo: simulan ang banayad na pagpapalakas ng grip at pinch: therapy putty, magaan na trabaho sa pinch at grip; patuloy na buong galaw sa lahat ng ibang joints; patuloy na pamamahala ng scar - Muling susihin ang anumang natitirang pamamaga o stiffness sa PIP/MCP at ayusin kung kinakailangan

Mga pamantayan para sa pag-progres - Kumpirmadong radiographic union; komportablong dulo ng daliri; kakayahang tumanggap ng banayad na pag-load nang walang sakit sa site ng fusion

Yugto 4 — unti-unting pagpapalakas at paglabas (linggo 8 hanggang 12)

Kapag solid na ang pagkakaisa, ipinagpatuloy ang pagpapalakas patungo sa normal na paggamit ng kamay, at tinatanggal ang mga paghihigpit sa paligid ng ikalabindalawang linggo.

Para sa iyong terapistang pang-kamay:

Edukasyon at mga paalala - Unti-unting pagpapalakas ng hawak at pisiyong; functional limit ~10 lb (≈4.5 kg) sa paligid ng 10 linggo - Walang paghihigpit mula sa paligid ng 12 linggo**, depende sa pagsusuri ng doktor

Pamamahala - Mga ehersisyo: gradadong resistibong hawak at pisiyong (putty → grippers → task-specific loading); ibalik ang buong functional na paggamit ng kamay - Isalang-alang ang paglabas kapag nakamit na ang matatag, walang sakit na dulo ng daliri, at halos normal na paggamit at lakas ng kamay - I-refer muli sa ang naggamot na doktor kung may sakit sa lugar ng pagkakaisa, alalahanin tungkol sa union, o mahinang functional na resulta

Mga pamantayan para sa paglabas - Nagkakaisa, walang sakit na pagkakaisa; buong galaw sa lahat ng hindi naka-fusion na kasukasuan; naibalik ang functional na pisiyong at hawak

Pagbabalik sa trabaho at gawain

Ang magaan na pang-araw-araw na paggamit ng iyong ibang mga daliri at natitirang bahagi ng kamay ay inirerekomenda mula sa simula, hangga't komportable; ang pinagsamang dulo ng daliri lamang ang pinipigilan. Ang pagmamaneho ay karaniwang muling sisimulan sa humigit-kumulang anim na linggo, pagkatapos mong matanggal ang makapal na splint at mabigyan ng ligtas na hawak at kontrol ang manibela; ito ay nakadepende sa pagpapasuso ni Dr. Hirpara sa iyong review, kaya magplano para sa tulong sa transportasyon sa mga unang linggo. Ang banayad na pinch at magaan na hawak ay karaniwang nagsisimula sa humigit-kumulang anim na linggo at unti-unting lumalakas mula sa walong linggo, pagkatapos ng pagkakaisa ng buto. Ang buo, mabigat, o pang-isport na paggamit ng kamay ay karaniwang naaabot sa humigit-kumulang labindalawang linggo. Ang mga timeline na ito ay mga gabay na batay sa konsenso ng mga eksperto imbes na mga tiyak na takdang oras: ang pagpapasuso ng iyong doktor at ang iyong X-ray (na kumpirming ang buto ay nakaisa) ang may unang prioridad.

Pagkatapos ng iyong protocol

Ang protocol na ito ay nagtatrabaho kasama ng pangkalahatang payo para sa paggaling ng klinika; tingnan din ang pamamahala ng post-operative na sakit, pag-aalaga sa sugat at pamamahala ng peklat. Ang phased na plano sa itaas ay sumasalamin sa publikadong gabay sa rehabilitasyon pagkatapos ng arthrodesis ng DIP joint, at ang iyong patuloy na paggaling ay pinamamahalaan nang indibidwal ni Dr. Hirpara at ng iyong hand therapist ayon sa kung paano gumagaling ang iyong daliri.

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

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/

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

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.