Interposition arthroplasty and reconstruction of the extensor apparatus in severe boutonniere deformity

ABSTRACT

Injuries of the hand finger joints can often lead to severe functional disability and rapid development of stiff joints. Although; Splinting and arthrodesis have been recommended because of the random results achieved by other reconstructive procedures, atrhrodesis for the young active patients should be reserved for limited causes and other arthroplasty techniques restoring joint mobility should be considered. A technique for interposition arthroplasty of the proximal inter-plalangeal [PIP] joint in sever type boutonniere deformity is described in this current study. It involves minimal resection of intra-articular adhesions and the use of autogenous fascia lata, and reconstruction of the extensor apparatus. Between May 2006 and May 2007 at the Orthopaedic Surgery Department of Mansoura University Hospital, 6 autogenous fascia lata interposition arthroplasties conducted on PIP joints of six patients of chronic post-traumatic sever type [stage III] boutonniere deformity according to Nalebuff and Millender classification [Terrono et al., 1990]. The resulted total active range of motion of the operated PIP joints ranged from 45 to 75 degrees. The restored range of motion constitutes from 42.9% to 71.4% of the normal range of motion of the PIP joint [Hume et al., 1990]. The operated PIP joints were stable and the restored motion was pain-free. All our patients were satisfied with both the functional and cosmetic outcomes. The method is simple, safe, and easily reproducible. In selected cases itcan offer restoration of pain-free active motion