A central slip injury can look minor early and declare itself later as a boutonnière deformity.
This page explains how a central slip injury / early boutonnière is commonly managed, in plain language, based on Dr. Kee's typical approach to this injury.
Every fracture is different. Treatment varies based on the exact fracture pattern, displacement, age, whether surgery is needed, bone quality, other injuries, and how an individual heals. This page is general education, not your personal treatment plan — always follow the specific instructions given to you by Dr. Kee's office.
A central slip injury can look minor early and declare itself later as a boutonnière deformity.
PIP extension must be protected while the DIP keeps moving.
This fracture is generally treated without surgery. Instead, it is protected in a cast, splint, or brace so the bone can heal in a good position on its own.
Continuous PIP extension splinting with the DIP free, often 6 weeks for an acute closed injury.
Light hand use while protecting the PIP.
For a full explanation of what these weight-bearing terms mean, see our Weight-Bearing Guide.
Actively flex the DIP while maintaining PIP extension; no unprotected PIP flexion initially.
Hand therapy is strongly helpful for splint fit and tendon-gliding program.
Early follow-up in 1–2 weeks; reassess extension and deformity progression.
Every fracture moves through the same general phases, though the exact timing is different for every patient:
Work or School: Modified work as needed.
Sports or High-Risk Activity: Return when extension is maintained and sport-specific function is restored.
Open injury, displaced avulsion, unstable joint, or inability to maintain PIP extension.
See our full When to Call page for the difference between routine office contact and emergency evaluation.
Continuous PIP extension splinting with the DIP free, often 6 weeks for an acute closed injury.
Your surgeon will guide when it's safe to return to these activities based on how your specific fracture is healing. Follow the instructions given specifically to you.
If operative, per fixation.
Every fracture heals differently. If you have questions about your treatment plan, reach out to Dr. Kee's office.