What are treatment options for Boutonniere deformity?

Updated: Jan 18, 2018
  • Author: Jay E Bowen, DO; Chief Editor: Craig C Young, MD  more...
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Answer

Both grade I and II injuries are treated by splinting the PIP joint in full extension, leaving the distal joint free to actively flex. The adjacent metacarpophalangeal and DIP joints should be allowed to have full range of motion. Splinting or buddy taping should continue for 6-8 weeks until there is pain-free motion. During this time, a program of active and passive range of motion at the DIP joint remobilizes the lateral bands and allows the central slip to heal at its proper length.

Grade III boutonnieres demonstrate a PIP joint flexion contracture greater than 30° and loss of flexion of the distal joint. An effort is made to correct the PIP flexion contracture by splinting or casting before an operative procedure that includes release of any residual contracture.

Grade IV deformities present with a fixed PIP flexion contracture and degenerative change in the joint. For treatment, the PIP joint is held in hyperextension. Surgery results in little gain of active motion.

Arthrodesis is often necessary to correct this deformity. Patients with a chronic boutonniere deformity, either from misdiagnosis or neglect, should be referred to a hand surgeon for evaluation and treatment. Complete recovery may not be possible at this time.


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