THE BOUTONNIÈRE DEFORMITY

A Review of 101 Patients with Division of the Central Slip of the Extensor Expansion of the Fingers

¹ Department of Hand Surgery, Derbyshire Royal Infirmary, Derby, England

1. A series of 106 central slip injuries has been reviewed.

2. Although the boutonnière deformity in many cases may be no more than a cosmetic defect, this survey has shown that in some instances it can constitute a slowly progressive lesion, with considerable disability and gross deformity of a digit.

3. Conservative treatment seems to be superior to operation, at least in those patients seen within six weeks of injury. Treatment by splintage alone yielded in this series a 75 per cent success rate, whereas operation showed only 50 per cent success.

4. When a sizeable fragment of bone has been avulsed from the middle phalanx, suture of the fragment in position is indicated and gives remarkably satisfactory results.

5. Injuries with soft-tissue loss over the proximal interphalangeal joint may yield successful results after suture or plastic repair of the tendon, and wound closure by split-skin grafts or local rotation flaps.

6. Poor results tend to occur in cases complicated by phalangeal fracture or by multiple hand injuries, and it may be advisable to defer the repair of the central slip until recovery from the other injuries has been completed.

7. With gross disruption of the proximal interphalangeal joint primary arthrodesis is probably indicated.