Central Slip Tenotomy With Distal Repair in the Treatment of Severe Chronic Mallet Fingers

Treatment of chronic extensor tendons lesions of the fingers

“…Through a transverse approach, Rozmaryn recommended excision of 50% of the central slip's P. Bellemère / Chirurgie de la main xxx (2015) xxx-xxx width (3 of 6 mm), about 5 mm proximal to the joint line to avoid the lateral bands and triangular ligament [36]. According to Rozmaryn, this genuine CS tenectomy is justified based on the conclusions of Hiwatari's biomechanical study showing that the residual DIP extensor lag is less when more of the CS was excised on the dorsal side of P1 [37].…”

“…Postoperative PIP splint immobilization in extension for 2 weeks is recommended to avoid or prevent PIP extension deficit [35,36]. The DIP joint must be immediately mobilized.…”

“…Fowler's technique corrects mallet finger with a mean residual postoperative extensor lag of 10 degrees or less [35][36][37][38][39][40] (Fig. 11).…”

“…It is not unheard of to observe gradual improvement in the DIP extensor lag in the months following the procedure (up to 1 year), along with correction of any resulting PIP extension deficit [34,35]. The occurrence of secondary boutonniere deformity is rare, and has been reported in 4.5% of published cases [35][36][37][38][39][40]. This can be prevented by preserving the triangular ligament and lateral bands during the tenotomy, and transient postoperative PIP immobilization in extension.…”

“…This can be prevented by preserving the triangular ligament and lateral bands during the tenotomy, and transient postoperative PIP immobilization in extension. Fowler's technique can be combined with a procedure on the terminal tendon over the DIP joint, as recommended by Rozmaryn when the mallet finger's extensor lag is significant [36]. Biomechanical studies, performed by Chao and then Hiwatari, have shown that Fowler's technique is not totally effective when the DIP extensor lag is greater than 36 degrees [37,41].…”