Boutonniere Deformity

Treatment of chronic extensor tendons lesions of the fingers

“…As many others, we recommend this procedure whenever possible in cases with significant PIP extension deficits [34,47,52,55]. Oblique pinning of the joint with a 1.0 or 1.2 mm K-wire is often necessary, with the K-wire being placed volar to the lateral slips.…”

“…The procedure is performed under local anesthesia with a sensory nerve block; this allows the number and size of the tenotomies to be adjusted according to the improvement in flexion obtained intraoperatively. Isolated Fowler/Dolphin tenotomy is indicated for patients who are only concerned with the DIP flexion deficit or when the PIP deficit is 30 degrees or less [51,52]. An increase of about 40 degrees in DIP flexion can be achieved [53] and a reduction in the PIP extension deficit has been observed in nearly half the cases [53,54].…”

“…Release and dorsalization of the lateral slips generally precedes secondary repair of the central slip in the same surgery session. [16,34,47,52,55].…”

“…This consists of removing 2-3 mm of the lengthened callus and suturing the central slip [52,[55][56][57] or reattaching it at the P2 base using bone anchors or wire cerclage if avulsed [58]. As many others, we recommend this procedure whenever possible in cases with significant PIP extension deficits [34,47,52,55].…”

Proximal Interphalangeal Joint Injuries

“…Most patients achieve a very good result, although there may be a mild extensor lag of perhaps 10-20°, although this is not normally of functional consequence. Patients who present a little later, often after a few weeks, with some fi xed fl exion deformity, are best treated with stretching of the PIP joint into full extension and once that is achieved then splinting as above [ 5 ]. Surgical treatment should almost always be avoided, as it is fraught with complications and unreliable outcomes.…”