Clarification of Extensor Tenotomy for Finger Deformities

Area of Science:

• Hand Surgery
• Orthopedic Surgery
• Reconstructive Surgery

Background:

• Fowler extensor tenotomy is a common eponym for finger extensor tenotomies.
• Distinguishing between proximal Fowler and distal Dolphin tenotomies is crucial for effective treatment.
• Swan neck and boutonniere deformities require specific surgical approaches.

Purpose of the Study:

• To clarify the terminology and distinct applications of proximal Fowler and distal Dolphin extensor tenotomies.
• To differentiate the indications for each surgical technique based on deformity type.
• To explain the anatomical structures and biomechanical principles involved.

Main Methods:

• Review and clarification of surgical terminology and indications.
• Description of techniques for proximal Fowler tenotomy (central slip tenotomy) for swan neck deformities.
• Description of techniques for distal Dolphin tenotomy (lateral conjoined band release) for boutonniere deformities.
• Explanation of adjunctive procedures like tendon imbrication, reinsertion, and reconstruction.
• Utilization of intraoperative and animated videos to demonstrate surgical principles.

Main Results:

• Proximal Fowler tenotomy is indicated for swan neck deformities, particularly with significant distal interphalangeal joint extensor lag.
• Distal Dolphin tenotomy is indicated for boutonniere deformities, addressing proximal interphalangeal joint hyperflexion.
• Specific adjunctive procedures are recommended based on the deformity and tenotomy type.

Conclusions:

• Accurate differentiation and application of proximal Fowler and distal Dolphin tenotomies are essential for correcting specific finger deformities.
• Understanding the underlying anatomy and biomechanics guides surgical success in treating swan neck and boutonniere deformities.
• This clarification aids surgeons in selecting the appropriate extensor tenotomy technique for optimal patient outcomes.