Successful Boutonniere Reconstruction With Wide-Awake Local Anesthesia No Tourniquet.

Purpose: In this retrospective study, we evaluated the results of central slip reconstruction with a modified Snow's technique under wide-awake local anesthesia no tourniquet.

Methods: Between 2016 and 2019, 13 patients with boutonniere deformity were operated. All of the patients had boutonniere deformity with a passively correctable proximal interphalangeal joint. In 7 patients, temporary proximal interphalangeal joint transfixation with a K-wire to secure the repair was preferred. For the rest of the patients, postoperative follow-up was done with an orthosis. All patients were referred to a hand therapist for postoperative rehabilitation.

Results: The mean interval between the injury time and the surgery was 55.7 days. After the surgery, the average proximal interphalangeal joint flexion was 104.8° and the loss of proximal interphalangeal joint extension was 6.15°. The average distal interphalangeal flexion was 65.3°. Seven cases had excellent results, 4 patients had good results, and 2 patients had fair results.

Conclusions: Our study demonstrated that with a modified Snow technique, encouraging results can be achieved for neglected central slip injuries in which primary repair is impossible. Surgery under wide-awake local anesthesia no tourniquet enables the surgeon to check the stability of the repair, and early active motion with relative motion flexion orthoses can be started with confidence.

Type Of Study/level Of Evidence: Therapeutic IV.