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Chronic Boutonniere Deformities, Supple, or Stiff: A New Surgical Technique With Early Mobilization in 11 Cases

Dubois, Elodie MD*; Teboul, Frederic MD, MS; Bihel, Thomas MD; Goubier, Jean-N. MD, PhD§

Techniques in Hand & Upper Extremity Surgery: June 2017 - Volume 21 - Issue 2 - p 37–40
doi: 10.1097/BTH.0000000000000152
Techniques
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Injuries to the central slip of the extensor mechanism can lead to a Boutonniere deformity with important functional consequences. We report a series of 11 patients treated by lengthening-dorsalizing the lateral bands and tightening the central slip with early mobilization. The average age of the patients was 42 years (14;52). The extension defect of the proximal interphalangeal (PIP) joint was 64 degrees (80;55) and the hyperextension of the distal interphalangeal joint was 10 degrees (15;5). The surgery was performed with peripheral nerve block (sensitive), allowing dynamic adjustment of the tendinous sutures. With a dorsal incision, a tenolysis of the extensor was performed. The central slip was tightened and the lateral bands dorsalized by cross-stitches over the PIP joint. The active flexion/extension was tested, and then lengthening of the lateral bands by “mesh graft” tenotomy was performed over the second phalange. There was no immobilization. The deformity was improved in 10 patients with a total flexion of the finger. The mean lack of extension in the PIP was 8 degrees (0;20) and the active flexion of the distal interphalangeal joint was 80 degrees (70;85). There was 1 failure. The majority of techniques necessitate an immobilization of 3 to 6 weeks. Our procedure uses the elastic properties of the elongation and allows immediate mobilization. The result can be compromised in case of insufficient tendinous surface or if postoperative instructions are not followed.

*CHRU Lille/CH Lens, Lille University Hospital, Lille

Paul d'Egine Private Hospital

§Hopital privé Paul d’Egine, Champigny sur Marne

CHU Amiens, Amiens University Hospital, Amiens

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Elodie Dubois, MD, CHRU Lille/CH Lens, 2, avenue Oscar Lambret, Lille 59037, France. E-mail: elodie.dubois23@gmail.com.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved