Boutonniere deformity due
to incompetence of the digital extensor
mechanism at the proximal interphalangeal joint results in a zig zag
deformity. Supple cases may respond to splinting. All operations for
fixed deformities involve terminal tendon lengthening, which may be
combined with central slip reconstruction and/or PIP joint release.
Simple terminal tendon release in this context is referred to as a
Fowler tenotomy or Fowler's tenotomy. Complete correction with surgery
is uncommon. Long term results of Fowler tenotomy alone are not known.
Long standing PIP contractures from Dupuytren's disease may result in
secondary Boutonniere deformity. Although most commonly treated with
open surgery for both conditions, these cases demonstrate percutaneous
terminal tendon release for boutonniere at the same setting as
percutaneous Dupuytren release.
The advantages of this technique are simplicity, and in the case of
Dupuytren's, increasing passive PIP joint extension by retensioning the
extensor mechanism. The disadvantages are unpredictability of
effectiveness and a strong tendency for recurrence.
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