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Surgical treatment of the boutonnière deformity
Hossein Towfigh1, Peter Gruber
1Abteilung für Unfall-, Hand- und plastische Wiederherstellungschirurgie, Malteser Krankenhaus, Albert-Struck-Strasse 1, D-59039, Hamm. hossein.towfigh@malteser.de
Objective:
Complete restoration of extensor function.
Indications:
Closed, open, and remote injuries of the extensor mechanism at the proximal interphalangeal (PIP) joint with corresponding loss of function.
Contraindications:
Contracture of the PIP. Loss of the articular surfaces. Unfavorable soft-tissue conditions including inflammation.
Surgical Technique:
Exposure of site of lesion over the PIP. Reconstruction of the central slip either with neighboring tendinous tissue or a tendon transplant, depending on the kind of injury. Temporary immobilization of the joint with a Kirschner wire or a wire suture according to Lengemann for temporary relief of the reconstructed tendon.
Postoperative Management:
Immobilization of the finger on an intrinsic-plus splint for approximately 2 weeks. Thereafter, only the PIP is immobilized on a PIP splint permitting movements of the neighboring joints for 2-3 weeks.
Results:
The boutonnière deformity was seen in 172 patients of whom 124 were treated surgically. Follow-up of 114 patients after an average of 40 months (6-126 months). Based on the score according to Geldmacher et al. an excellent result was seen in 24, a good in 54, a satisfactory in 22, and a poor result in 14 patients.
