- 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,
- 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.