Postoperative Treatment

No matter how accurate the internal fixation, a successful outcome largely depends on the postoperative treatment. After surgery, edema is caused by accumulation of excessive fluid in the intercellular space. This swelling diminishes perfusion and may lead to congestion, dysregulation, and increased risk of infection. Pain and immobilization result in muscle atrophy. Muscle and ligament contractures decrease the range of motion. The following postoperative measures are essential:

Analgesia and exercise therapy Adequate analgesia must be ensured as otherwise the patient will likely not tolerate or actively participate in appropriate postoperative treatment. Priority should be given to an effective and more consistent application of preferably active mobilization, muscle pump activity by active isometric muscle exercise, wherever possible, and elevation of the limb above shoulder height. Instructions must be repeated often and emphatically! Slings should be avoided.

Wound monitoring Regular dressing changes, under analgesia/anesthesia (children) if necessary, are essential. The plaster cast should be checked for cleanliness, fit, functional position, and pressure sites, and replaced if necessary. Hematomas must be evacuated surgically under sterile conditions. Partially opening the wound or removing sutures is not sufficient in this case.

Early mobilization Early mobilization starts as soon as possible, depending on the wound and the patient’s general condition. Physical therapy for the shoulder and elbow starts on the first postoperative day to avoid disorders in the chain of movements of the upper extremity. Proprioceptive neuromuscular facilitation (PNF) techniques are helpful.

Depending on progress, mobilization is increased with controlled physical therapy, which is supplemented by occupational therapy later on. Independent activity by the patient is encouraged. Active physical therapy is preferable to passive measures.

Additional measures Additional physical measures include intermittent ice application for pain relief and to improve perfusion.

When used appropriately, passive exercises can help to prevent adhesions of tendons and sliding surfaces. Treatment can be supported by manual therapy to maintain rolling and sliding joint movements with traction and translation.

Lymph drainage reduces swelling but is only indicated after the wound is well healed.

Treatment of scars consisting of pressure dressings, compression hose, and compression gloves is occasionally helpful. After complete wound healing, scar ointments will have a positive effect, not least for psychological reasons.

Occupational therapy As soon as the internal fixation is stable on motion and loading, physical therapy must be supplemented with occupational therapy. Functional improvements are achieved by having the patient perform active tasks with the injured hand in order to attain pain-free precision, power, and key grips. The occupational therapy repertoire also includes self-help training, provision of aids and, if necessary, use of a dynamic splint. Sensibility training to improve sensation should not be neglected.

Note

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