Surgical Management for Boutonniere Disease
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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
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