The relative motion flexion splinting in the treatment of boutonnière deformity of the finger: presentation of the method and a review of the literature.

Andrzej Żyluk

Abstract


The rupture of the central slip of the extensor tendon of the finger causes a deformity, characterized by flexion at the proximal interphalangeal (PIP) joint and hyperextension at the distal interphalangeal joint (the boutonnière deformity). Various treatments are used in this condition, including conservative and operative methods, however, there is no standard treatment guideline. The idea the relative motion flexion splint method is based on an importance of keeping the metacarpo-phalangeal joint of the involved finger relatively flexed compared with these joints of the adjacent fingers. This is done with a relative motion flexion splint. Flexion in the metacarpo-phalangeal joint allows the lateral slips of the extrinsic extensor tendon to pull the lateral bands dorsal to the axis of the PIP joint. It allows also the relaxation of the intrinsic muscles and the lateral bands so they can migrate dorsal to the axis of the joint. This article presents the method and provides literature review about outcomes of treatment of the condition.

Keywords


boutonnière deformity; extensor tendon injury; central slip tear; relative motion flexion splint

Full Text:

PDF

References


Żyluk A, Szlosser Z, Mazurek T. Zastarzałe uszkodzenia ścięgien. In: Żyluk A, editor. Chirurgia ręki. Warszawa: Medipage; 2017. p. 583-8.

Burton RI. Extensor tendons late reconstruction. In: Green DP, editor. Operative hand surgery. New York: Churchill Livingstone; 1988. p. 2073-116.

Pillukat T, Windolf J, Schädel-Höpfner M, Fuhrmann RA, van Schoonhoven J. Extensor tendon injuries at the level of the proximal interphalangeal joint. Unfallchirurg 2021;124(4):265-74.

Lee JK, Lee S, Kim S, Jo S, Cho JW, Han SH. Anatomic repair of the central slip with anchor suture augmentation for treatment of established boutonnière deformity. Clin Orthop Surg 2021;13:243-51.

Merritt WH, Wong AL, Lalonde DH. Recent developments are changing extensor tendon management. Plast Reconstr Surg 2020;145(3):617e-28e.

Hirth MJ, Howell JW, O’Brien L. Relative motion orthoses in the management of various hand conditions: A scoping review. J Hand Ther 2016;29(4):405-32.

Wong AL, Wilson M, Girnary S, Nojoomi M, Acharya S, Paul SM. The optimal orthosis and motion protocol for extensor tendon injury in zones IV-VIII: a systematic review. J Hand Ther 2017;30:447-56.

Merritt WH. Relative motion splint: active motion after extensor tendon injury and repair. J Hand Surg Am 2014;39:1187-94.

Miller JE, Le BQ. An improvised approach to relative motion extension splinting in the emergency room. Plast Reconstr Surg Glob Open 2022;10(3):e4211.

Merritt WH, Jarrell K. A paradigm shift in managing acute and chronic boutonnière deformity: anatomic rationale and early clinical results for the relative motion concept permitting immediate active motion and hand use. Ann Plast Surg 2020;84(3S Suppl 2):S141-50.

Arslan OB, Sigirtmac IC, Ayvali C, Bas CE, Ayhan E, Bilgin SS, et al. The use of relative motion flexion orthoses for chronic boutonnière deformity. J Hand Surg Am 2022;3:S0363-5023(22)00464-6. doi: 10.1016/j.jhsa.2022.08.007.

Shaw AV, Verma Y, Tucker S, Jain A, Furniss D. Relative motion orthoses for early active motion after finger extensor and flexor tendon repairs: a systematic review. J Hand Ther 2023;36(2):332-46.

Hirth MJ, Howell JW, O’Brien L. Two case reports – use of relative motion orthoses to manage extensor tendon zones III and IV and sagittal band injuries in adjacent fingers. J Hand Ther 2017;30(4):546-57.




DOI: https://doi.org/10.21164/pomjlifesci.1014

Copyright (c) 2025 Andrzej Żyluk

License URL: https://creativecommons.org/licenses/by-nc-nd/3.0/pl/