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.
6 weeks:
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.
7 weeks:
Passive Range of Motion exercises may be initiated as needed.
The Gutter splint is continued between exercises as needed.
NOTE:
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.