Surgical Management for Boutonniere Disease
Year: 2024
Type: article
Abstract: Boutonniere disease is a hand injury causing extension lag or restriction in the proximal interphalangeal joint and hyperextension in the distal interphalangeal joint. This condition often arises from direct laceration or closure damage to the central tendon, rheumatoid arthritis, osteoarthritis, Dupuytren contracture, pulley injury, burns, and other conditions. Surgical management for Boutonniere deformity relies on the expertise of the attending physician and involves both non-surgical and surgical options. In acute cases, conservative therapy should be pursued, while in chronic cases, conservative management may be advised. Surgical intervention is used to transform excessive extension force of the distal interphalangeal joint into extension force of the proximal interphalangeal joint. This is necessary to heal an open rupture of the central tendon. Surgical techniques for chronic deformity are complex due to variables and hand surgeons' expertise. There is no definitive surgical therapy for persistent buttonhole deformity, but several approaches have been documented in case studies. These include terminal tenotomy, collateral band surgery, central tendon surgery, tendon transfer and grafting, stepwise extension mechanism readjustment surgery, and arthrodesis. Central tendon surgery addresses the central tendon, where injured tissue transforms into scar tissue, resulting in delayed extension of the proximal interphalangeal joint. Tendon transfer or grafting have been documented for rotator cuff mechanism rehabilitation, but no definitive guidance exists for these techniques. Curtis treatment introduced a sequential therapy approach for traumatic buttonhole deformity, which involves splinting, excising the transverse reticular ligament, resecting and lengthening the collateral ligament, and repositioning the core tendon. Arthrodesis may be applicable in cases of advanced arthritis, coronal plane deformity, functional impairment, or elderly patients. There are no definitive indications for surgical interventions for persistent buttonhole deformity, and outcomes may be variable or inferior. Understanding the deformity, its progression, and patient's functional constraints is crucial for effective treatment
Authors: Juan Jesús Ortega Landeros, José Emiliano González Flores, Instituto Tecnológico y de Estudios Superiores de Monterrey Campus Ciudad de México, Miguel De Hoyos Riebeling, Centro Médico ABC, CDMX, Williams Antonio Barrios García, Instituto Superior de Ciências da Saúde Carlos Chagas, Rio de Janeiro, Brazil, Lynda Patricia Paredes López, Centro Médico Nacional La Raza, Omar Serna Delgado, Jairo Guadalupe Sifuentes Cortez, Beatriz Huiyu Li Gómez, Jorge Alonso Jacobo Cervantes, Hernández Ortiz José Antonio, Alberto Jaramillo Sastré, Facultad de Medicina UNAM
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4403336602