Surgical treatment of the boutonnière deformity.
OBJECTIVE
Complete restoration of extensor function.


METHODS
Closed, open, and remote injuries of the extensor mechanism at the proximal interphalangeal (PIP) joint with corresponding loss of function.


METHODS
Contracture of the PIP. Loss of the articular surfaces. Unfavorable soft-tissue conditions including inflammation.


METHODS
Exposure of site of lesion over the PIP. Reconstruction of the central slip either with neighboring tendinous tissue or a tendon transplant, depending on the kind of injury. Temporary immobilization of the joint with a Kirschner wire or a wire suture according to Lengemann for temporary relief of the reconstructed tendon.


METHODS
Immobilization of the finger on an intrinsic-plus splint for approximately 2 weeks. Thereafter, only the PIP is immobilized on a PIP splint permitting movements of the neighboring joints for 2-3 weeks.


RESULTS
The boutonnière deformity was seen in 172 patients of whom 124 were treated surgically. Follow-up of 114 patients after an average of 40 months (6-126 months). Based on the score according to Geldmacher et al. an excellent result was seen in 24, a good in 54, a satisfactory in 22, and a poor result in 14 patients.
Towfigh
Hossein
H
Abteilung für Unfall-, Hand- und plastische Wiederherstellungschirurgie, Malteser Krankenhaus, Albert-Struck-Strasse 1, D-59039, Hamm. hossein.towfigh@malteser.de
Gruber
Peter
P
D000328:Adult; D001864:Bone Wires; D005260:Female; D005384:Finger Joint / Q000002:abnormalities* / Q000601:surgery*; D006228:Hand Deformities, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D020127:Recovery of Function; D013536:Suture Techniques; D013709:Tendon Transfer / Q000379:methods; D013710:Tendons / Q000002:abnormalities* / Q000601:surgery*; D016896:Treatment Outcome