Hossein Towfigh1, Peter Gruber. 1. Abteilung für Unfall-, Hand- und plastische Wiederherstellungschirurgie, Malteser Krankenhaus, Albert-Struck-Strasse 1, D-59039, Hamm. hossein.towfigh@malteser.de
Abstract
OBJECTIVE: Complete restoration of extensor function. INDICATIONS: Closed, open, and remote injuries of the extensor mechanism at the proximal interphalangeal (PIP) joint with corresponding loss of function. CONTRAINDICATIONS: Contracture of the PIP. Loss of the articular surfaces. Unfavorable soft-tissue conditions including inflammation. SURGICAL TECHNIQUE: Exposure of site of lesion over the PIP. Reconstruction of the central slip either with neighboring tendinous tissue or a tendon transplant, depending on the kind of injury. Temporary immobilization of the joint with a Kirschner wire or a wire suture according to Lengemann for temporary relief of the reconstructed tendon. POSTOPERATIVE MANAGEMENT: Immobilization of the finger on an intrinsic-plus splint for approximately 2 weeks. Thereafter, only the PIP is immobilized on a PIP splint permitting movements of the neighboring joints for 2-3 weeks. RESULTS: The boutonnière deformity was seen in 172 patients of whom 124 were treated surgically. Follow-up of 114 patients after an average of 40 months (6-126 months). Based on the score according to Geldmacher et al. an excellent result was seen in 24, a good in 54, a satisfactory in 22, and a poor result in 14 patients.
OBJECTIVE: Complete restoration of extensor function. INDICATIONS: Closed, open, and remote injuries of the extensor mechanism at the proximal interphalangeal (PIP) joint with corresponding loss of function. CONTRAINDICATIONS: Contracture of the PIP. Loss of the articular surfaces. Unfavorable soft-tissue conditions including inflammation. SURGICAL TECHNIQUE: Exposure of site of lesion over the PIP. Reconstruction of the central slip either with neighboring tendinous tissue or a tendon transplant, depending on the kind of injury. Temporary immobilization of the joint with a Kirschner wire or a wire suture according to Lengemann for temporary relief of the reconstructed tendon. POSTOPERATIVE MANAGEMENT: Immobilization of the finger on an intrinsic-plus splint for approximately 2 weeks. Thereafter, only the PIP is immobilized on a PIP splint permitting movements of the neighboring joints for 2-3 weeks. RESULTS: The boutonnière deformity was seen in 172 patients of whom 124 were treated surgically. Follow-up of 114 patients after an average of 40 months (6-126 months). Based on the score according to Geldmacher et al. an excellent result was seen in 24, a good in 54, a satisfactory in 22, and a poor result in 14 patients.