Year Book: Operative Treatment of the Post-Traumatic Boutonniere Deformity

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A Modification of the Direct Anatomical Repair Technique. Caroli, A. Zanasi, S. Squarzina, PB. Guerra, M. Pancaldi, G. Abstract/Commentary:|1992 Year Book of Hand Surgery. Article 6-10.|Original Background.--Direct anatomical repair of the central slip is the simplest approach to the treatment of post-traumatic boutonniere deformity, particularly in chronic cases that have complete passive motion. A modification of the direct anatomical repair technique was used to treat 20 patients. Technique.--A swallow-tailed flap of approximately 3 mm is excised from the fibrous tissue between the 2 ends of the central slip. The transverse retinacular ligament often is released when there is lack of flexion at the distal interphalangeal joint. The proximal end of the central slip is advanced up to the coaptation with the distal edge of the scarred capsular tissue at the insertion on the middle phalanx, and end-to-end repair is performed in correct tension. Results.--Of the 20 patients with chronic boutonniere deformity treated by this technique, 18 were followed-up for a mean of 26 months. Of these 18, 72% had excellent results and 5.5% had good results. The fair results in 17% were attributed to the patients' uncooperativeness with postoperative splinting and physiotherapy. Conclusions.--The swallow-tailed flap technique offers several advantages. These include wider suture area, uniform distribution of tension at the suture site, more accurate control of tension for the correction, and avoidance of overlapping suture of the tendon ends.