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Boutonniere Injuries: Chronic Boutonniere

- See:
- Discussion:
     - refers to Boutonniere injuries more than 2 months after injury;
     - is difficult to treat due to shortening of:
          - central slip & contracture of the lateral bands;
          - transverse retinacular ligaments;
          - oblique retinacular ligaments;
          - accessory colateral ligaments of the proximal IP joint;
          - as lesion worsens, MCP joint remains in extension to compensate;
     - first attempt to restore motion of PIP joint w/ splinting (DIP free);
          - if active motion is restored, then surgery is not required;
          - if passive motion is restore, but active motion is deficient, surgery will be required;
     - central slip reconstruction:
          - consider splitting the lateral bands longitudinally for 2 cm and suturing them together in the midline, which will re-create a functional central slip;
                   - the lateral bands initially need to freed from their attachements to the oblique and transverse retinacular bands;
     - w/ severe deformity, consider transecting lateral bands inorder to convert their power toward extending dorsal base of middle phalanx;
           - severed lateral bands will no longer hold DIP in extension;
           - DIP flexion is maintained by action of oblique retinacular ligament (Littler procedure);
     - absence of central tendon insertion:
           - if lateral bands are also deficient, tendon graft may be needed;
    - PIP arthroplasty: fails frequently,
    - arthrodesis:
           - indicated for recurrent synovitis & recurrent deformity;
           - arthrodesis of index finger usually provides greatest amount of function w/ the least amount of morbidity;
           - fuse at 25-50 deg of flexion at PIP (more for ulnar digits);
           - arthrodesis of long & ring fingers can produce a quadriga effect due to the tethering of the profundus tendons

Chronic boutonniere deformity--an anatomic reconstruction.

The management of chronic posttraumatic boutonniere deformity.

Correction of the severe nonrheumatoid chronic boutonniere deformity with a modified Matev procedure.

Biomechanical evaluation of chronic boutonniere reconstructions.

Tendon reconstruction for postburn boutonniere deformity.

Operative treatment of the post-traumatic boutonnière deformity. A modification of the direct anatomical repair technique.