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Revisiting the Curtis Procedure for Boutonniere Deformity Correction.

Khoo LS, Senna-Fernandes V - World J Plast Surg (2015)

View Article: PubMed Central - PubMed

Affiliation: Ivo Pitanguy Institute, Rua Dona Mariana 65, Botafogo, Rio De Janeiro, Brazil.

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Boutonnière deformity (BD) is a debilitating deformity where the proximal interphalangeal (PIP) joint of the finger is flexed, and the distal interphalangeal (DIP) joint is hyperextended... Together, these changes cause hyperextension at the DIP joint in addition to the already hyperflexed PIP joint... Indications/Contraindications All patients should be subjected to a minimum of 1 month splinting prior to attempting surgical treatment... A variety of splints such as the Bunnel safety pin splint or dynamic spring based splits are available... The PIP joint is held in a neutral position while the DIP joint is flexed by the examiner... If the DIP joint does not flex, the retinacular (collateral) ligaments or proximal interphalangeal capsule are tight... If the PIP joint is flexed and the DIP joint flexes easily, the ORL are tight and the capsule is normal... The test result is considered negative if passive flexion of the DIP joint is still possible with the PIP joint maintained in extension .The test result is positive if flexion of the DIP joint is not possible with the PIP joint in extension... A positive Haines-Zancolli test result equates poor outcome with conservative treatment... The rationale is to create a “Mallet finger” thereby decreasing the tone of the DIP joint and allowing the extensor mechanism to slide proximally to increase the extensor tension at the PIP joint... Therefore the surgical procedures used should not risk or sacrifice existing function... The staged Curtis procedure allows the surgeon to stop at the stage where adequate result is obtained... The more modern dynamic splints used toward the end of mobilization may shorten the splinting duration needed in the postoperative period... The authors declare no conflict of interest.

No MeSH data available.


Marking of the central slip with methylene blue dye
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Figure 7: Marking of the central slip with methylene blue dye

Mentions: However if an extensor lag of more than 20 degrees is still evident after stage II, Curtis advocated proceeding directly to stage IV. The central slip is dissected free (Figure 7) and advanced about 4 to 6 mm into a drill hole in the dorsal base of the middle phalanx (Figure 8). The lateral bands, which are no longer tight are loosely sutured to the central tendon.9


Revisiting the Curtis Procedure for Boutonniere Deformity Correction.

Khoo LS, Senna-Fernandes V - World J Plast Surg (2015)

Marking of the central slip with methylene blue dye
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4537613&req=5

Figure 7: Marking of the central slip with methylene blue dye
Mentions: However if an extensor lag of more than 20 degrees is still evident after stage II, Curtis advocated proceeding directly to stage IV. The central slip is dissected free (Figure 7) and advanced about 4 to 6 mm into a drill hole in the dorsal base of the middle phalanx (Figure 8). The lateral bands, which are no longer tight are loosely sutured to the central tendon.9

View Article: PubMed Central - PubMed

Affiliation: Ivo Pitanguy Institute, Rua Dona Mariana 65, Botafogo, Rio De Janeiro, Brazil.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Boutonnière deformity (BD) is a debilitating deformity where the proximal interphalangeal (PIP) joint of the finger is flexed, and the distal interphalangeal (DIP) joint is hyperextended... Together, these changes cause hyperextension at the DIP joint in addition to the already hyperflexed PIP joint... Indications/Contraindications All patients should be subjected to a minimum of 1 month splinting prior to attempting surgical treatment... A variety of splints such as the Bunnel safety pin splint or dynamic spring based splits are available... The PIP joint is held in a neutral position while the DIP joint is flexed by the examiner... If the DIP joint does not flex, the retinacular (collateral) ligaments or proximal interphalangeal capsule are tight... If the PIP joint is flexed and the DIP joint flexes easily, the ORL are tight and the capsule is normal... The test result is considered negative if passive flexion of the DIP joint is still possible with the PIP joint maintained in extension .The test result is positive if flexion of the DIP joint is not possible with the PIP joint in extension... A positive Haines-Zancolli test result equates poor outcome with conservative treatment... The rationale is to create a “Mallet finger” thereby decreasing the tone of the DIP joint and allowing the extensor mechanism to slide proximally to increase the extensor tension at the PIP joint... Therefore the surgical procedures used should not risk or sacrifice existing function... The staged Curtis procedure allows the surgeon to stop at the stage where adequate result is obtained... The more modern dynamic splints used toward the end of mobilization may shorten the splinting duration needed in the postoperative period... The authors declare no conflict of interest.

No MeSH data available.