In boutonniere deformity management, which statement about the proximal interphalangeal (PIP) joint orthosis is correct?

• A. Wear the orthosis continuously up to 6 weeks
• B. Remove the orthosis every hour for passive motion exercises
• C. Wear the orthosis only at night to maintain the PIP joint in extension
• D. Wear the orthosis during the day, but remove it at night

Answer: (A)

Maintaining the PIP joint in extension with continuous immobilization is the key idea here. In boutonniere deformity, the central slip of the extensor mechanism is disrupted, so the PIP joint tends to flex and the extension mechanism weakens. Keeping the PIP extended with a dedicated orthosis for the full healing window allows the central slip to repair without being repeatedly stressed by movement, reducing the risk of a persistent flexion deformity. The usual approach is to wear the orthosis continuously for about six weeks, with the DIP free to move as tolerated, and then gradually reintroduce range of motion once healing is underway. Short bursts of motion or removing the splint for activities, or wearing it only at night, would not provide the sustained extension needed during this critical period and can compromise recovery.