For a middle-aged, right-handed man with rheumatoid arthritis, a disabling boutonniere deformity of the right index finger, and an extension contracture of the DIP joint, optimal treatment would be (AIPG 2010)
|A||Release of the lateral bands distal to the DIP joint|
|B||Silicone arthroplasty of the PIP joint|
|C||Reconstruction of the lateral bands distal to the DIP joint|
|D||Arthrodesis of the PIP joint in 25 to 30° of flexion|
Arthrodesis of the PIP joint in 25 to 30° of flexion
a. The PIP flexion and DIP hyperextension seen in boutonniere deformities result from volar subluxation of the lateral bands following rupture or attenuation of the insertion of the central slip into the base of the middle phalanx.
b. Fixed hyperextension of the DIP joint indicates long-standing deformity.
c. Soft-tissue procedures usually fail if the DIP joint is fixed in extension.
d. Arthroplasties, especially if extensor balance is not restored, also commonly fail. Arthrodesis is the preferred procedure for such cases.