Surgical management of chronic boutonniere deformity.

Purpose: Boutonniere deformity is caused by damage to the central slip of the extensor tendon hood with secondary palmer migration of the lateral bands. Accordingly, patients complain of disfigurement and impairment of function due to hyperextension of their DIP. The aim of this study is to evaluate the results of surgical treatment of chronic boutonniere deformity by using a modified technique.

Patients And Methods: Twelve patients with posttraumatic boutonniere deformity were available for follow up as a retrospective study. They were treated by release of the extensor expansion proximal to the distal insertion of the oblique retinacular ligaments with proximal recession of the extensor tendon and lifting the lateral bands dorsally onto the PIP joint after separation of the transverse retinacular ligaments from their insertion volarly. All patients had closed injury. The mean age was 32 years (range: 16-48 years). The average follow-up period was 33 months (range: 26-38 months). We included only cases with deformities that were totally correctable passively with or without joint osteoarthritic changes.

Results: Preoperatively the average PIP joint extension deficit was 60° and postoperatively the average is reduced to 7°, preoperative the average DIP motion was 10° of hyperextension, post-surgery the average DIP active flexion was 75°. The final outcomes were 58.3% excellent, 33.3% good, and 8.3% poor.

Discussion: This modified technique gave (91.6%) excellent and good results. The extensor tendon acted mainly on the PIP joint and allowing the DIP joint to flex freely. The procedure is simple and provides long-term good results.

Level Of Evidence: Therapeutic case series, level 1V.