How to do the boutonniere Elastoplast splint technique (BEST) for the management of mallet deformities

Abstract

The applications of a simple technique are invaluable. I have used the boutonniere (button-hole) Elastoplast (adhesive dressing) splint technique (BEST) throughout my hand surgical career for simple and complicated injuries. With patients with fractures over 30 per cent of the articular surface of the distal interphalangeal joint (DIPJ) this technique avoids open intervention and open reduction internal fixation (ORIF). Unsuccessful conservative management where the treatment sometimes extends over eight months also can be successfully handled by this technique. The accompanying audiovisual presentation is the basis of this teaching tool. Slides are supplemented by voiceover descriptions explaining the intricacies of this three-layered Elastoplast technique creating a boutonniere reduction position which needs to be reapplied with fresh Elastoplast weekly over a three week period. This produces an excellent outcome. I have included perspectives from patients in the video presentation where the details of the technique are discussed and the patient’s satisfaction is evident.