Preoperative splinting aimed at maximizing range of motion is essential before beginning any open treatment of deformity of boutonniere deformity.
3 - 6 weeks:
The PIP Joint may be pinned in extension.
The pin is removed.
A Gutter splint holding the PIP joint in full extension is fitted to be worn between exercises and at night.
Active Range of Motion exercises are initiated 15 min/hr.
Passive Range of Motion exercises may be initiated as needed.
The Gutter splint is continued between exercises as needed.
The indication of Passive Range of Motion exercises may be postponed or discontinued entirely if an extensor lag is present of is greater than 20 degrees.
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