Chronic Boutonniere Deformity: Cross-Lateral Band Technique Using Palmaris Longus Autograft

Abstract

The purpose of this study was to evaluate the outcomes of treatment of chronic boutonniere deformity with a reconstruction technique using palmaris longus autograft. Seven patients with chronic, posttraumatic, flexible boutonniere deformities referred to our clinic between January 2010 and September 2014 were included in the study. In all 7 patients, the lateral bands were deficient or damaged beyond repair. A novel reconstruction technique for chronic boutonniere deformity utilizing palmaris longus autograft was used. The 2 lateral bands were reconstructed by attaching the palmaris longus tendon grafts from the lateral part of the central slip proximally to the volar aspect of the distal phalanx distally using pull-out sutures. The grafts were positioned so that they crossed over one another at the level of the middle phalanx. The patients were followed for a mean of 14 months (range, 12-16 months). The principal outcome measure was the range of motion of the proximal (PIP) and distal (DIP) interphalangeal joints. Before surgery, the average PIP joint active flexion was 69° (range, 60°-85°). After surgery, the average PIP joint active flexion increased to 92° (range, 90°-100°). Before surgery, the average PIP joint extension deficit was 54° (range, 40°-60°); after surgery, the average deficit was reduced to 7° (range, 5°-15°). Before surgery, the average DIP posture was 9° of hyperextension (range, 5°-12°); after surgery, DIP hyperextension was reduced to 2° (range, 0°-5°). Before surgery, the average DIP active flexion was 40° (range, 35°-55°); after surgery, this increased to 55° (range, 43°-72°). No patients developed a DIP flexion contracture. In the chronic boutonniere deformity, when the lateral bands are deficient or damaged, our cross-lateral band reconstruction technique using palmaris longus autograft is a treatment option with satisfactory results. Therapeutic V.