The Experts below are selected from a list of 216 Experts worldwide ranked by ideXlab platform
Wyndell H Merritt - One of the best experts on this subject based on the ideXlab platform.
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a paradigm shift in managing acute and chronic Boutonniere Deformity anatomic rationale and early clinical results for the relative motion concept permitting immediate active motion and hand use
Annals of Plastic Surgery, 2020Co-Authors: Wyndell H Merritt, Kathy JarrellAbstract:BACKGROUND: We have utilized relative motion splinting for early motion following acute repair of Boutonniere injuries, and we have developed nonoperative orthosis-based therapy for the treatment of chronic injuries. We offer our early clinical experience using relative motion flexion splinting for Boutonniere deformities and explain the anatomic rationale that permits immediate active motion and hand use following acute injury or repair. For chronic Boutonniere Deformity, we offer a nonsurgical management method with low morbidity as a safe alternative to surgery. METHODS: Our understanding of the extrinsic-intrinsic anatomic interrelationship in Boutonniere Deformity offers rationale for relative motion flexion splinting, which is confirmed by cadaver study. Our early clinical results in 5 closed and 3 open acute and 15 chronic cases have encouraged recommending this management technique. For repaired open and closed acutely injured digits, we utilize relative motion flexion orthoses that place the injured digits in 15 degrees to 20 degrees greater metacarpophalangeal flexion than its neighboring digits and otherwise permit full active range of motion and functional hand use maintaining the 15 degrees to 20 degrees greater metacarpophalangeal flexion for 6 weeks. In fixed chronic Boutonniere cases, serial casting is utilized to obtain as much proximal interphalangeal extension as possible (at least -20 degrees ), and then relative motion flexion splinting and hand use is instituted for 12 weeks. RESULTS: Our acute cases obtained as good as, or better range of motion than, conventional management techniques, with early full flexion and maintenance of extension without any recurrences. The most significant difference is morbidity, with ability to preserve hand function during healing and the absence of further therapy after 6 weeks of splinting. Patients with chronic Boutonniere Deformity presented from 8 weeks to 3 years following injury (averaging 31 weeks) and were 15 to 99 years of age (averaging 42 years). All were serially casted to less than -20 degrees (averaging -4 degrees ) and maintained that level of extension after 3 months of relative motion flexion splinting. All achieved flexion to their palm, and all met the Steichen-Strickland chronic Boutonniere classification of "excellent." There were no recurrent progressive Boutonniere deformities in either acute or chronic cases and no instances of reflex sympathetic dystrophy/chronic regional pain syndrome (RSD/CRPS). CONCLUSIONS: Relative motion flexion splinting affords early active motion and hand use with excellent range of motion achieved following acute open Boutonniere repair or closed Boutonniere rupture with less morbidity than conventional management. Chronic Boutonniere Deformity will respond to relative motion flexion splinting if serial casting can place the proximal interphalangeal joint in less than -20 degrees extension, and the patient actively uses the hand in a relative motion flexion orthosis for 3 months, recovering flexion. No further therapy was needed in our cases. We believe this management technique should be attempted for chronic Boutonniere Deformity as a preferable alternative to surgery, which remains an option if needed.
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relative motion splint active motion after extensor tendon injury and repair
Journal of Hand Surgery (European Volume), 2014Co-Authors: Wyndell H MerrittAbstract:The relative motion splint was initially developed to facilitate postoperative rehabilitation after repair of extensor tendon injuries at the dorsum of the hand and forearm. It has subsequently been used for rehabilitation of sagittal band injuries and after repair of closed attrition extensor tendon ruptures in rheumatoid arthritis. This is much less awkward than other braces and can readily be worn during normal past-time and work activities. This so-called immediate controlled active motion splinting protocol has also more recently been applied to both operative and nonsurgical rehabilitation for Boutonniere Deformity.
Seongno Jeong - One of the best experts on this subject based on the ideXlab platform.
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traumatic Boutonniere Deformity of the thumb
Archives of Plastic Surgery, 2004Co-Authors: Hongsil Ju, Ho Gwon, Seongno JeongAbstract:Traumatic Boutonniere Deformity of the thumb is rare in non-rheumatoid patients. Non-rheumatoid patient develops a Boutonniere Deformity of the thumb following a closed injury to the dorsoradial aspect of the metacarpophalangeal joint. The patient had an extensor lag of the metacarpophalangeal joint and paradoxical hyperextension of the interphalangeal joint. The patient required surgical treatment which included advancement and reattachment of the extensor pollicis brevis insertion and imbrication of the dorsoradial capsule to restore the anatomical alignment of the extensor pollicis longus. Conservative care of the metacarpophalangeal joint may be effective, but once a Boutonniere Deformity is developed, surgical treatment is necessary.
K Tsubo - One of the best experts on this subject based on the ideXlab platform.
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traumatic Boutonniere Deformity of the thumb
Journal of Hand Surgery (European Volume), 2000Co-Authors: L J Cardon, K TsuboAbstract:We report three patients who presented 3 to 8 months after sustaining a closed injury to the dorsoradial aspect of the metacarpophalangeal joint of the thumb. All three patients had an extensor lag of the metacarpophalangeal joint and paradoxical hyperextension of the interphalangeal joint. There were no collateral ligament injuries. The patients required surgical treatment which included advancement and reattachment of the extensor pollicis brevis insertion and imbrication of the dorsoradial capsule to restore the anatomical alignment of the extensor pollicis longus. Surgical treatment of dorsoradial injuries to the thumb metacarpophalangeal joint may be required for injuries that result in subluxation of the extensor pollicis longus tendon and a Boutonniere Deformity of the thumb.
Edward A. Nalebuff - One of the best experts on this subject based on the ideXlab platform.
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Boutonniere rheumatoid thumb Deformity
Journal of Hand Surgery (European Volume), 1990Co-Authors: Andrew L Terrono, Lewis H. Millender, Edward A. NalebuffAbstract:Abstract The Boutonniere Deformity is the most common rheumatoid thumb Deformity. It can be classified into early, moderate, and advanced types, depending on whether the Deformity is passively correctable. Fifty-three patients with 74 procedures from the basis of these recommendations. The early type treated with metacarpophalangeal joint synovectomy and extensor pollicis longus rerouting have a high recurrence rate of 64%. Metacarpophalangeal joint fusion is the procedure of choice for the moderate type with isolated metacarpophlangeal joint involvement. Metacarpophalangeal joint arthroplasty is best suited for the low-demand, older patients with borderline proximal and distal joints. Interphalangeal joint releases done with metacarpophalangeal joint fusions have a high recurrence rate and are not recommended. In advanced cases metacarpophalangeal joint arthroplasty and interphalangeal joint fusion is our procedure of choice.
G Pancaldi - One of the best experts on this subject based on the ideXlab platform.
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operative treatment of the post traumatic Boutonniere Deformity a modification of the direct anatomical repair technique
Journal of Hand Surgery (European Volume), 1990Co-Authors: A Caroli, S Zanasi, P B Squarzina, M Guerra, G PancaldiAbstract:We report 20 cases of post-traumatic Boutonniere Deformity treated by a modification of the direct anatomical repair technique, particularly indicated in late cases which have complete passive motion. A swallow-tailed flap is excised from the fibrous tissue between the two ends of the central slip. The proximal one is then advanced up to the coaptation with the distal edge of the scarred capsular tissue at the insertion on the middle phalanx to which it is sutured in correct tension. Excellent results have been obtained in 72% of cases and good in 5.5%. The 16% of fair results are probably due to the fact that patients didn't use the splint post-operatively and didn't cooperative with physiotherapy.