Posttraumatic chronic boutonniere deformity correction using ala carte reconstruction and local anesthesia surgery, A case report

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INTRODUCTION AND IMPORTANCE: Posttraumatic boutonnière deformities are complex clinical problems that are often poorly understood. Nevertheless, there are no established therapy guidelines, and there is little data to support the various treatment outcomes. In this report, we want to report on the treatment using an ala carte approach of already established procedures. CASE PRESENTATION: An 18-year-old male, complained about a crooked left middle finger for 1 year before admission, with a history of traumatic injury due to getting slashed by a machete. The operative procedure of releasing the central slip, lateral band, and transverse retinacular ligament, reconstruction using the Ohshio method, terminal tendon tenotomy, and fixation using K-wire. Intraoperative range of motion was evaluated. After 3 months post-operation, the patient was able to do full flexion and extension of the middle finger and after 1 year follow-up, the alignment and the function were satisfactory. CLINICAL DISCUSSION: Chronic boutonnière deformity occurs when central slip injury prevents full PIP joint extension, causing lateral slip tension and DIP extension. Acute cases benefit from splinting and rehabilitation to avoid permanent deformities. Splinting, including relative motion flexion splinting, is crucial early on. For chronic cases, surgery such as the Curtis procedure or central slip tenotomy may be necessary. The Curtis method involves staged tendon repair, while tenotomy focuses on direct tendon reconstruction. Both approaches show promising results but may leave residual lag. Individualized treatment and timely intervention are essential for optimal outcomes. CONCLUSION: The Ala carte approach of reconstruction procedure using anesthesia yields good results. The importance of an intraoperative active range of movement evaluation plays a crucial role so that correction can be made accordingly.

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