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Wyndell H Merritt – 1st expert on this subject based on the ideXlab platform
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 useAnnals 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.
relative motion splint active motion after extensor tendon injury and repairJournal 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 – 2nd expert on this subject based on the ideXlab platform
traumatic Boutonniere Deformity of the thumbArchives 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 – 3rd expert on this subject based on the ideXlab platform
traumatic Boutonniere Deformity of the thumbJournal 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.