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Boutonniere rheumatoid thumb deformity
A Terrono1, L Millender, E Nalebuff
1New England Baptist Hospital, Boston, Mass.
The Journal of Hand Surgery
|November 1, 1990
Summary
The boutonniere deformity, a common rheumatoid thumb issue, requires tailored surgical approaches. Metacarpophalangeal joint fusion is best for moderate cases, while arthroplasty suits advanced stages.
Area of Science:
- Hand surgery
- Rheumatology
- Orthopedic surgery
Background:
- The boutonniere deformity is the most common thumb deformity in rheumatoid arthritis.
- Deformities are classified as early, moderate, or advanced based on passive correctability.
Purpose of the Study:
- To recommend surgical procedures for different types of rheumatoid thumb boutonniere deformities.
- To evaluate the efficacy of various surgical interventions based on a patient cohort.
Main Methods:
- Review of 74 procedures in 53 patients with rheumatoid thumb boutonniere deformities.
- Classification of deformities into early, moderate, and advanced types.
- Analysis of surgical outcomes including recurrence rates for different procedures.
Main Results:
- Early type: Metacarpophalangeal (MCP) joint synovectomy and extensor pollicis longus (EPL) rerouting showed a 64% recurrence rate.
- Moderate type: MCP joint fusion is recommended for isolated MCP joint involvement.
- Advanced type: MCP joint arthroplasty combined with interphalangeal (IP) joint fusion is the preferred treatment.
- IP joint releases with MCP fusions are not recommended due to high recurrence.
Conclusions:
- Surgical treatment for rheumatoid thumb boutonniere deformity should be type-specific.
- MCP joint fusion is effective for moderate, isolated deformities.
- MCP joint arthroplasty with IP joint fusion offers a viable solution for advanced cases.