Clarification of Extensor Tenotomy for Finger Deformities

This article clarifies the terminology and different applications of proximal Fowler extensor tenotomy and distal Dolphin extensor tenotomy. Although Fowler is a popular eponym for all finger extensor tenotomies, proximal Fowler tenotomy is specifically indicated for swan neck deformities, whereas distal Dolphin tenotomy is indicated for boutonniere deformities. For swan neck deformities with a distal interphalangeal joint extensor lag of greater than 40°, central slip tenotomy can be combined with terminal tendon imbrication or reinsertion. More distal Dolphin tenotomy of the lateral conjoined bands is complemented by centralization of the lateral bands or central slip reconstruction to correct hyperflexion of the proximal interphalangeal joint. The pertinent anatomic structures, mechanisms of release, and biomechanical principles have been demonstrated using intraoperative and animated videos of the surgical techniques.