Can a finger's bending trajectory be temporarily altered if it is placed in an intrinsic plus (IP) brace almost 24 hours a day?

Continuous Intrinsic Plus Bracing Does Not Permanently Alter Finger Bending Trajectory

Prolonged immobilization in an intrinsic plus (IP) brace will temporarily restrict finger motion during the healing period, but once the brace is removed and active motion is restored, the finger's bending trajectory will return to its natural pattern determined by the fracture healing, soft tissue integrity, and any residual deformity—not by the brace position itself.

The Critical Problem: Immobilization-Induced Stiffness

The primary concern with near-continuous bracing (24/7) is not trajectory alteration, but rather the development of severe finger stiffness, which is one of the most functionally disabling complications following hand fractures 1, 2.

Why Stiffness Develops

• Edema and soft tissue contracture occur when fingers remain immobilized, leading to adhesions and joint capsule tightening 1
• Multiple anatomic structures become involved simultaneously—on average 3.1 different structures require release when surgical intervention becomes necessary for post-fracture stiffness 3
• Stiffness becomes extremely difficult to treat after fracture healing, often requiring multiple therapy visits and possibly additional surgical intervention 1, 2

Evidence Against Trajectory Alteration

Fracture Healing Determines Final Position

• The fracture reduction and healing determine the finger's ultimate alignment and motion pattern, not the splint position 1
• Finger motion does not adversely affect an adequately stabilized fracture regarding reduction or healing 1, 2
• After simple fracture treatment, range of motion in both fractured and unfractured fingers returns to essentially normal when early motion is implemented 4

Temporary vs. Permanent Changes

• Any motion restriction from bracing is reversible once mobilization begins 1
• The bending trajectory returns to the pattern dictated by bone alignment, tendon integrity, and joint mechanics—not by the previous immobilization position 3, 4

The Correct Approach: Early Finger Motion

Immediate Mobilization Protocol

Active finger motion exercises should begin immediately following diagnosis, even with the fracture stabilized 1, 2:

• Patients should move fingers regularly through complete range of motion from the first encounter 1, 2
• This is an extremely cost-effective intervention that provides significant impact on patient outcomes 1
• Early motion prevents complications without requiring pharmaceutical intervention or additional visits 1

Critical Timing for Therapy

If surgical release for stiffness becomes necessary 3:

• Patients starting physical therapy within 7 days of release improved by 59° of total active motion
• Those starting therapy after 7 days (average 11.5 days) actually lost 19° of motion
• This demonstrates that delay in mobilization is a major risk factor for persistent or worsened stiffness 3

Common Pitfalls to Avoid

Do Not Restrict Finger Motion

• Failure to encourage early finger motion leads to significant stiffness requiring extensive intervention 1, 2
• Obstruction by splints or casts, combined with patient apprehension or lack of understanding, contributes to finger stiffness 1
• Even with wrist immobilization, fingers must remain mobile 1, 2

Brace Duration Limits

• Continuous application of pressure above 9.3 kPa for more than 2-3 hours increases risk of skin necrosis and pressure ulcerations 1
• Pelvic binders (as an example of continuous compression devices) should not be kept for more than 24-48 hours due to soft tissue complications 1
• The same principle applies to finger bracing—prolonged continuous immobilization causes harm 1

Surgical Outcomes When Stiffness Develops

If 24/7 bracing leads to stiffness requiring surgical intervention 3:

• Mean total active motion improved modestly from 150° preoperatively to 191° postoperatively
• Overall increase in motion is generally limited, though functional improvement can be obtained
• Patients involved in worker's compensation demonstrated significantly lower improvement (9° vs. 58° in non-compensation patients)
• This underscores that prevention through early motion is far superior to surgical correction 3

Clinical Bottom Line

The intrinsic plus brace position does not "train" or permanently alter the finger's bending trajectory. Once removed, the finger will bend according to its anatomic healing and soft tissue integrity. The real danger is that 24/7 immobilization will cause severe stiffness that may never fully resolve, even with aggressive therapy or surgery 1, 2, 3. Unless there is a specific indication requiring continuous immobilization (such as tendon repair protection), fingers should be mobilized early and regularly to prevent this devastating complication 1, 2.