From the Research
The initial management for a patient with Boutonnière deformity involves relative motion flexion splinting, which allows for immediate active motion and hand use, as this approach has been shown to achieve excellent range of motion with less morbidity than conventional management techniques 1.
Key Considerations
- The use of relative motion flexion splinting is based on the anatomic rationale that permits immediate active motion and hand use following acute injury or repair, and has been confirmed by cadaver studies 1.
- For acute cases, relative motion flexion orthoses are utilized, placing the injured digits in 15° to 20° greater metacarpophalangeal flexion than its neighboring digits, and otherwise permitting full active range of motion and functional hand use for 6 weeks 1.
- For fixed chronic boutonniere cases, serial casting is utilized to obtain as much proximal interphalangeal extension as possible (at least -20°), and then relative motion flexion splinting and hand use is instituted for 12 weeks 1.
Management Approach
- The management approach should prioritize preserving hand function during healing, with the goal of achieving excellent range of motion and minimizing morbidity 1.
- Relative motion flexion splinting has been shown to be effective in achieving these goals, with no recurrent progressive boutonniere deformities or instances of reflex sympathetic dystrophy/chronic regional pain syndrome (RSD/CRPS) reported in the study 1.
Comparison to Other Studies
- While other studies have discussed the importance of distinguishing between boutonniere and pseudoboutonniere deformities 2, and the use of corrective splinting, injections, synovectomy, terminal tenotomy, extensor reconstruction, or salvage surgery in the treatment of boutonniere finger deformity in rheumatoid arthritis 3, the most recent and highest quality study supports the use of relative motion flexion splinting as the initial management approach 1.