Deformidad ng Boutonnière Impormasyon

Ano ang nararamdaman mo

Maaaring mapansin mong ang kasu-kasuan ng gitnang daliri ay yumuyuko papasok habang ang kasu-kasuan ng dulo ay lumalabas. Ang pagbabago sa hugis na ito ay tinatawag na boutonniere deformity. Ito ay nangyayari kapag ang mga tendon sa itaas ng iyong daliri ay lumipat sa hindi tamang posisyon. Maaaring maranasan mo ang sakit sa base ng daliri kung saan ito ay nagtatagpo sa iyong kamay. Ang sakit ay maaari ring nasa gitnang kasu-kasuan ng daliri mismo.

Ang mga pang-araw-araw na gawain ay madalas na nagiging mahirap. Ang pag-abot sa likod upang isara ang bra ay maaaring maging mahirap. Ang pagtatakip ng damit ay maaaring maging hindi komportable o masakit. Maaari kang makipagbuno upang gumawa ng buong kamay. Ang simpleng pagkapit ay maaaring magdulot ng hindi komportableng pakiramdam. Ang deformity ay maaaring manatili kahit subukan mong mag-stretch o magpahinga.

Ang mga sintomas ay madalas na lumala matapos ang aktibidad. Maaaring maranasan ang stiffness kapag gising ka sa umaga. Ang sakit sa gabi ay maaaring mangyari, lalo na kung matutulog ka sa gilid. Ang presyon sa kamay ay maaaring mag-irita sa mga nasirang tendon. Kung mayroon kang rheumatoid arthritis, ang kondisyon ay maaaring sumunod sa ibang landas sa paglipas ng panahon. Kung wala kang arthritis o trauma, ang humigit-kumulang 13% ng mga tao ay nagkakaroon ng isyu na ito.

Mahalagang malaman kung ano ang eksaktong nararamdaman mo. Ang tunay na boutonniere deformity ay magkaiba sa isang katulad na pinsala na tinatawag na pseudoboutonniere. Kailangang paghiwalayin ng iyong surgeon ang dalawa upang pumili ng tamang paggamot. Ang pag-unawa sa iyong partikular na sintomas ay tumutulong sa amin na magplano ng iyong paggamot. Gusto naming ibalik ang kakayahan at kaginhawaan ng iyong kamay.

Kung mayroon kang swan neck deformity, ang dulo ng daliri ay maaaring yumuko pa sa ibaba sa paglipas ng panahon. Ang pag-unlad na ito ay maaaring mangyari nang dahan-dahan. Ang maagang pag-unawa sa iyong sintomas ay nagdudulot ng mas magandang resulta. Magpapakita kami ng maingat na pagsusuri sa iyong kamay. Titingnan namin kung paano gumagalaw ang iyong mga kasu-kasuan at kung saan nasa sakit. Ito ay tumutulong sa amin na desisyonin kung kailangan mo ng splinting o iba pang paggamot.

Ano ang nangyayari talaga

Mayroong kumplikadong sistema ng mga tendon ang iyong daliri na gumagana tulad ng mga lubid upang matulungan kang yumuko at tuwidin ito. Sa gitnang kasukasuan ng iyong daliri, mayroong isang partikular na tendon na tinatawag na central slip. Ang tendon na ito ay nakaposisyon sa itaas ng kasukasuan at tumutulong sa pagtutwid ng iyong daliri. Kapag nasugatan o namamaga ang tendon na ito, maaari itong magsira o lumuwag.

Kapag nabigo ang central slip, nagbabago ang balanse ng mga puwersa sa iyong daliri. Masyadong matindi ang paghila ng mga tendon sa gilid ng iyong daliri, na nagdudulot ng pag-yuko paitaas ng gitnang kasukasuan. Sabay nito, maaaring yumuko palabas ang dulo ng iyong daliri. Ito ang nagdudulot ng kitang-kita na kurba sa iyong daliri, na ito ang tinatawag na Boutonnière deformity. Ang pinakamahalagang salik sa isyung ito ay ang mga pagbabagong nangyayari sa mga tendon at kaugnay na estruktura, lalo na sa mga maagang yugto.

Maaaring mangyari ang kondisyong ito pagkatapos ng direktang sugat, tulad ng putol o pagkakasira. Maaari rin itong mangyari nang natural, lalo na sa mga taong may rheumatoid arthritis, kung saan ang pamamaga ay nagdudulot ng pagkasira ng kasukasuan. Sa ilang kaso, ito ay lumalabas nang walang malinaw na trauma o arthritis, na apektado ang humigit-kumulang 13% ng mga tao sa mga ganitong sitwasyon. Ang pangunahing layunin ng paggamot ay panatilihin ang pagkakahanay ng kasukasuan, ibalik ang katatagan, at payagan kang gumalaw nito muli.

Kung mayroon kang deformity na ito, maaaring mahirap para sa iyo na tuwidin nang ganap ang iyong daliri. Ang mga non-surgical na paggamot, tulad ng mga splint o casting, ay maaaring tumulong na mapabuti ang iyong saklaw ng galaw ng isang hanggang dalawang antas. Gayunpaman, maaaring manatili ang deformity kahit pagkatapos ng dedikadong konservatibong pamamahala. Dito naging kritikal ang tumpak na diagnosis. Kailangan nating kilalanin ang tunay na Boutonnière deformity mula sa isang katulad na isyu na tinatawag na pseudoboutonniere, dahil magkaiba ang pamamahala. Ang pag-unawa sa mga mekanikang ito ay tumutulong sa amin na pumili ng tamang landas para sa iyong paggaling.

Mga maitutulong namin dito

Ang pamamaraan ni Dr. Kieran Hirpara, isang surgeon sa upper-limb sa Mater Private Hospital Rockhampton, ay nakatuon sa pagtutugma ng gamutan sa tiyak na sanhi ng iyong deformity ng daliri. Kailangan muna nating tukuyin kung mayroon kang tunay na boutonniere deformity o katulad na isyu na tinatawag na pseudoboutonniere injury. Mahalagang pagkakaiba ito dahil nagbabago nito ang paraan ng pamamahala sa iyong paggaling. Simulan namin sa isang kumpletong pagsusuri, kasama ang kasaysayan, pagsusuri, at imahen kung kinakailangan, upang maunawaan ang anatómiya at yugto ng problema.

Para sa maraming pasyente, nagsisimula kami sa non-operative na paggamot. Madalas itong kasama ang serial casting upang tulungan ang pagwasto ng daliri, sinundan ng tatlong buwan ng paggamit ng relative motion flexion orthotic. Ang espesyal na splint na ito ay nagbibigay-daan sa iyo na galawin ang iyong daliri habang pinoprotektahan ang mga nagpapagaling na tisyu. Layunin ng physiotherapy na mapabuti ang iyong range of motion at bawasan ang stiffness. Inaasahan ang pag-unlad ng isa hanggang dalawang antas ng galaw sa pamamagitan ng dedikadong conservative na pamamahala. Gayunpaman, pakitandaan na maaaring manatili ang deformity kahit pagkatapos ng gamutang ito. Kung ang sakit ay isang malaking isyu, maaaring pag-usapan namin ang gamot sa sakit o mga anti-inflammatory na opsyon. Sa ilang kaso, ginagamit ang mga injection tulad ng cortisone o hyaluronic acid upang bawasan ang pamamaga at magbigay ng ginhawa, bagama't nag-iiba-iba ang tagal ng epekto depende sa indibidwal.

Isinasalang-alang ang operasyon kapag ang conservative na paggamot ay hindi nagbigay ng sapat na pag-unlad, o kung ang problema ay istruktural at acute. Hinahanap namin ang mga senyales na ang mga malambot na tisyu o tendon ay nagbago nang permanenteng. Kung inirerekomenda ang operasyon, ito ay isang shared na desisyon batay sa iyong mga layunin at tiyak na yugto ng iyong deformity. Para sa mga chronic na kaso, ang mga prosedura tulad ng tendon grafts ay maaaring wasto ang alignment. Sa rheumatoid arthritis, kung saan ang mga resulta ng long-term na reconstruction ng malambot na tisyu ay maaaring hindi maaasahan, maaaring pag-usapan namin ang mga salvage procedures kung bumalik ang deformity. Ang layunin ay ibalik ang function at epektibong tugunan ang deformity. Tinitiyak namin na nauunawaan mo ang inaasahang mga resulta bago magpatuloy.

Ano ang inaasahan

Ang iyong prognosis ay nakadepende sa tagal ng pagkakaroon mo ng deformity at kung ito ay may kaugnayan sa rheumatoid arthritis. Sa maraming kaso, hindi ito aayos nang sarili. Maaaring makamit ang pagpapabuti ng range of motion na may sukat na isa hanggang dalawang grado gamit ang nonoperative na paggamot, bagama't maaaring manatili ang deformity kahit matapos ang dedikadong conservative na pamamahala.

Kung ang iyong kaso ay chronic, madalas naming sinusubukan ang serial casting para sa sapat na extension, sinundan ng 3 buwan ng paggamit ng relative motion flexion orthotic bago isaalang-alang ang surgery. Ang pamamaraang ito ay nagdudulot ng katulad na resulta kumpara sa ibang mga paraan at dapat subukan bago ang surgical na interbensyon. Maaaring mapansin mo ang pagtaas ng galaw sa iyong mga joint ng daliri sa panahong ito. Gayunpaman, ang natural na kasaysayan ng deformity sa rheumatoid arthritis ay madalas na hindi maipapredict. Ang long-term na mga resulta pagkatapos ng soft tissue reconstruction para sa boutonniere deformity sa rheumatoid arthritis ay hindi maaasahan. Ang recurrent o persistent na deformity ay pinakamabuting gamutin gamit ang salvage procedure.

Para sa mga nangangailangan ng surgery, ang matagumpay na operatibong resulta ay nakadepende sa kumpletong preoperative na pagsusuri, tamang staging ng deformity, at wastong pagtatalaga ng oras ng paggamot. Hindi kami gumagamit ng iisang teknik para sa lahat ng deformity. Tinatantya namin ang tunay na dahilan bago mag-interbento. Halimbawa, ang Y-shaped na tendon graft ay isang kapaki-pakinabang na proseso para sa pagwawasto ng chronic boutonniere deformity, na nagbibigay ng magandang o napakahusay na resulta sa 16 sa 18 pasyente sa isang na-ulat na serye.

Dapat mong maunawaan na ang pagkakaiba ng tunay na boutonniere deformity mula sa pseudoboutonniere injury ay kritikal sa pagpaplano ng clinical na pamamahala. Ang prevalence ng boutonniere deformity nang walang rheumatoid arthritis o trauma ay humigit-kumulang 13%. Ibig sabihin, ang karamihan sa mga kaso ay may kaugnayan sa ibang mga salik. Gabay ka ng iyong surgeon sa mga pagkakaibang ito.

Ang recovery ay isang proseso, hindi agad na pagwawasto. Maaaring maranasan mo ang stiffness o limitadong galaw sa simula. Sa tamang staging at pagtatalaga ng oras, nakikita ng maraming pasyente ang makabuluhang pagpapabuti. Kung mabigo ang mga conservative na hakbang, ang surgery ay nag-aalok ng landas para sa pagwawasto. Layunin namin ang stability at function. Dapat mong inaasahan ang unti-unting pagbabalik sa mga araw-araw na gawain sa loob ng mga linggo hanggang buwan. Ang iyong pagkakaroon ng commitment sa therapy at paggamit ng orthotic ay may malaking papel sa iyong final na resulta.

Kailan kumonsulta sa doktor

Kumonsulta sa iyong doktor kung napansin mo ang patuloy na pagliko sa gitnang kasu-kasuan ng iyong daliri na hindi natutuwid. Magpakonsulta sa espesyalista kung mayroon kang patuloy na sakit na hindi bumababa kahit magpahinga, o kung ang daliri ay pakiramdam ay mahina o hindi matatag. Mag-ingat sa pagkakasara o pagbagsak ng daliri habang gumagalaw. Kung ang mga sintomas ay nakakaapekto sa iyong pagtulog o trabaho, o kung may biglaang paglala, huwag maghintay. Mahalaga ang tumpak na diagnosis dahil ang pagkakaiba ng tunay na boutonnière deformity mula sa pseudoboutonniere injury ay nagbabago ang paraan ng pamamahala ng iyong paggaling. Ang maagang pagsusuri ay tumutulong upang matukoy ang tamang landas ng paggamot para sa iyong partikular na sugat.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Differentiating a true boutonniere deformity from a pseudoboutonniere injury is critical in determining clinical management [2].
An understanding of the anatomy, clinical presentation, treatment options, and expected outcomes is crucial for optimal treatment of posttraumatic boutonnière and swan neck deformities [4].
The paper outlines the anatomy, pathoanatomy, and treatment concepts for boutonniere deformity, emphasizing that early treatment of central slip injuries can prevent the deformity [7].
The natural history of the boutonnière deformity in rheumatoid arthritis is outlined, and a simple method of repair is described [3].
The case extends understanding of congenital boutonniere deformity as various embryonic developmental failures and suggests a reliable surgical option involving central slip reconstruction [8].

Anatomy & Pathophysiology

A finite element model successfully replicated the behavior of the digit under specific scenarios, including the extension of the DIP joint during Elson's test [12].
Injury to the extensor mechanism, specifically the central slip, can lead to snapping or catching at the PIP joint [24].
Progressive damage to structures involved in Boutonniere deformity results in decreased extension of the PIP joint [25].
A release procedure based on precise anatomy redistributes forces acting on the interphalangeal joints to restore full extension and flexion [26].
Asymmetrical position of the distal phalanges during extension suggests a central slip lesion, while symmetrical position indicates the lesion is unlikely [28].
Irreducible volar dislocation of the PIP joint can be caused by interposition of the intact central slip [31].
In irreducible volar dislocations, the prognosis is better than in reducible dislocations because the extensor mechanism is displaced rather than disrupted [31].
Congenital hypoplasia of the extensor tendon central slip can be treated successfully with a static hand brace to keep the PIP joint in extension [35].

Classification

The boutonniere deformity requires subluxation of the lateral bands volar to the axis of rotation of the proximal interphalangeal (PIP) joint [15].
Anterior dislocation of the PIP joint is associated with ruptures of the central slip of the extensor mechanism and results in boutonniere deformity unless repaired [16].
Early treatment of central slip injuries can prevent the development of boutonniere deformity [7].
The natural history of boutonniere deformity in rheumatoid arthritis is distinct from other etiologies [3].
Congenital boutonniere deformity results from various embryonic developmental failures [8].
Boutonniere deformity can occur in the thumb without rheumatoid arthritis or trauma [11].
The prevalence of boutonniere deformity without rheumatoid arthritis or trauma is approximately 13% [11].

Clinical Presentation

Boutonniere deformities are closed soft tissue injuries of the extensor mechanism in zones I, III, and V [14].
Elson's test involves extension of the distal interphalangeal (DIP) joint [12].

Investigations

This article summarizes current concepts relating to the presentation and treatment of closed soft tissue injuries of the extensor mechanism in zones I, III, and V, commonly known as mallet finger, boutonniere deformities, and sagittal band injuries [14].
The article discusses injuries to the central slip (boutonniere) and annular pulleys in elite athletes, emphasizing the importance of anatomic knowledge, accurate diagnosis, and balancing early return to play with long-term risks [18].
The boutonniere deformity requires subluxation of the lateral bands volar to the axis of rotation of the PIP joint [15].
Anterior dislocation of the proximal interphalangeal joint is associated with ruptures of the central slip of the extensor mechanism and results in boutonnière deformity unless repaired [16].
Treating swan neck and boutonniere deformities of the PIP joint is a difficult challenge that requires understanding the cause, biomechanical changes, and articular status [17].
The study developed and validated a finite element model that successfully replicated the behavior of the digit under specific scenarios, including the extension of the DIP joint during Elson's test observed in cadaveric studies [12].

Treatment

Non-Operative Management

Serial casting for adequate extension followed by 3 months of relative motion flexion (RMF) orthotic use should be attempted prior to surgical intervention for chronic boutonniere deformity [1].
Chronic boutonniere deformity responds to relative motion flexion splinting if serial casting places the proximal interphalangeal joint in less than -20° extension and the patient actively uses the hand in a relative motion flexion orthosis for 3 months to recover flexion [5].
The use of relative motion flexion orthoses (RMFO) is effective in increasing active distal interphalangeal joint flexion and improving proximal interphalangeal joint extension in patients with Burton stage 1 chronic boutonniere deformity [23].
Improvement in digit range of motion is associated with the initiation of nonoperative treatment within 6 weeks [20].
The type or length of conservative treatment is not associated with differences in outcomes for nonoperative treatment of boutonniere deformity [20].

Operative Management

The natural history of boutonniere deformity in rheumatoid arthritis has been outlined, and a simple method of repair is described [3].
The Y-shaped tendon graft is a useful procedure for the correction of chronic boutonniere deformity, providing good or excellent results in 16 of 18 patients in a reported series [6].
When lateral bands are deficient or damaged in chronic boutonniere deformity, cross-lateral band reconstruction using palmaris longus autograft is a treatment option with satisfactory results [9].
Extensor tenotomy to correct a long-standing boutonniere deformity markedly lessens disability with restoration of flexion of the distal joint [10].
Transection of the terminal extensor tendon is a useful salvage procedure for boutonniere deformity [13].
Central slip reconstruction is a reliable surgical option for congenital boutonniere deformity [8].

Complications

Chronic boutonniere deformity may result from untreated or inadequately treated central slip injuries [7].
Differentiating a true boutonniere deformity from a pseudoboutonniere injury is critical to avoid inappropriate clinical management [2].
The natural history of boutonnière deformity in rheumatoid arthritis involves progressive deformity requiring repair [3].
Boutonnière deformity can occur in the thumb without underlying rheumatoid arthritis or trauma, with a prevalence of approximately 13% in such cases [11].
Chronic boutonniere deformity can lead to marked disability and loss of flexion of the distal joint if left uncorrected [10].

Recovery

The Y-shaped tendon graft is a useful procedure for correcting chronic boutonniere deformity, providing good or excellent results in 16 of 18 patients in a reported series [6].
Extensor tenotomy can correct long-standing boutonniere deformity by markedly lessening disability and restoring flexion of the distal joint [10].

Key Evidence

[L4] Similar results occurred for chronic boutonniere deformity using serial casting for adequate extension followed by 3 months of RMF orthotic use, which should be attempted prior to surgical intervention. [1] (10.1016/j.jht.2023.02.005)
[L5] Differentiating a true boutonniere deformity from a pseudoboutonniere injury is critical in determining clinical management. [2] (10.1016/j.jhsa.2022.10.019)
[L4] The natural history of the boutonnière deformity in rheumatoid arthritis is outlined, and a simple method of repair is described. [3] (10.2106/00004623-196951070-00009)
[L5] An understanding of the anatomy, clinical presentation, treatment options, and expected outcomes is crucial for optimal treatment of posttraumatic boutonnière and swan neck deformities. [4] (10.5435/jaaos-d-14-00272)
[L4] Chronic boutonniere deformity will respond to relative motion flexion splinting if serial casting can place the proximal interphalangeal joint in less than -20° extension, and the patient actively uses the hand in a relative motion flexion orthosis for 3 months, recovering flexion. [5] (10.1097/sap.0000000000002307)
[L4] The Y-shaped tendon graft can be a useful procedure for the correction of chronic boutonniere deformity; in our patient series, this provided good or excellent results in 16 of 18 patients. [6] (10.1016/j.jhsa.2021.01.003)
[L5] The paper outlines the anatomy, pathoanatomy, and treatment concepts for boutonniere deformity, emphasizing that early treatment of central slip injuries can prevent the deformity. [7] (10.1016/s0749-0712(21)00060-3)
[Case_report] The case extends understanding of congenital boutonniere deformity as various embryonic developmental failures and suggests a reliable surgical option involving central slip reconstruction. [8] (10.1016/j.jhsa.2014.05.030)
[L4] In chronic boutonniere deformity, when the lateral bands are deficient or damaged, the cross-lateral band reconstruction technique using palmaris longus autograft is a treatment option with satisfactory results. [9] (10.1016/j.jhsa.2017.04.010)
[L3] The prevalence of boutonnière deformity without rheumatoid arthritis or trauma is approximately 13%. [11] (10.1177/1753193417704610)
[L5] The study developed and validated a finite element model that successfully replicated the behavior of the digit under specific scenarios, including the extension of the DIP joint during Elson's test observed in cadaveric studies. [12] (10.1186/s13018-025-06329-3)
[L4] Transection of the terminal extensor tendon is a useful procedure for salvage of the boutonniere deformity. [13] (10.1016/s0749-0712(21)00065-2)
[L5] This article summarizes current concepts relating to the presentation and treatment of closed soft tissue injuries of the extensor mechanism in zones I, III, and V, commonly known as mallet finger, boutonniere deformities, and sagittal band injuries. [14] (10.1016/j.jhsa.2013.11.018)
[L5] The boutonniere deformity requires subluxation of the lateral bands volar to the axis of rotation of the PIP joint. [15] (10.1016/j.jhsa.2017.07.011)
[L4] Treating swan neck and boutonniere deformities of the PIP joint is a difficult challenge that requires understanding the cause, biomechanical changes, and articular status. [17] (10.1016/j.hcl.2017.12.006)
[Paper] The article discusses injuries to the central slip (boutonniere) and annular pulleys in elite athletes, emphasizing the importance of anatomic knowledge, accurate diagnosis, and balancing early return to play with long-term risks. [18] (10.1016/j.hcl.2012.05.044)
[L3] Improvement in digit ROM was associated with initiation of treatment within 6 weeks, but not with any particular type or length of conservative treatment. [20] (10.1016/j.jht.2025.02.013)
[L4] The use of RMFO is effective in increasing active distal interphalangeal joint flexion and improving PIP extension in patients with Burton stage 1 chronic boutonniere deformity. [23] (10.1016/j.jhsa.2022.08.007)
[Case_report] Hand surgeons should be aware that injury to the extensor mechanism and specifically the central slip can lead to snapping or catching at the PIP joint in the finger. [24] (10.1177/15589447221081876)
[Paper] Extension of the PIP joint decreases as these structures are progressively damaged. [25] (10.1016/s0363-5023(12)60014-8)
[L5] Asymmetrical position of the distal phalanges during extension suggests a central slip lesion, while symmetrical position indicates the lesion is unlikely. [28] (10.1177/175899830601100402)
[L4] The prognosis is far better after irreducible than after reducible volar dislocations because the extensor mechanism is displaced, not disrupted. [31] (10.2106/00004623-197860010-00023)
[L4] Congenital hypoplasia of the central slip can be treated successfully by using a static hand brace to keep the PIP joint in the extension position, especially with the frequent application of the hand brace. [35] (10.1177/1753193416676410)

References

[1] The relative motion concept in acute and chronic boutonniere deformity: Invited commentary. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2023.02.005

[2] Boutonniere Versus Pseudoboutonniere Deformities: Pathoanatomy, Diagnosis, and Treatment. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.10.019

[3] Correction of the Rheumatoid Boutonnière Deformity. The Journal of Bone & Joint Surgery. 1969. DOI: 10.2106/00004623-196951070-00009

[4] Posttraumatic Boutonnière and Swan Neck Deformities. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00272

[5] A Paradigm Shift in Managing Acute and Chronic Boutonniere Deformity. Annals of Plastic Surgery. 2020. DOI: 10.1097/sap.0000000000002307

[6] Y-Shaped Tendon Graft—A Technique in the Reconstruction of Posttraumatic Chronic Boutonniere Deformity. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.01.003

[7] BOUTONNIERE DEFORMITY. Hand Clinics. 1995. DOI: 10.1016/s0749-0712(21)00060-3

[8] Restoration of the Central Slip in Congenital Form of Boutonniere Deformity: Case Report. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.05.030

[9] Chronic Boutonniere Deformity: Cross-Lateral Band Technique Using Palmaris Longus Autograft. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.04.010

[10] Extensor Tenotomy for Chronic Boutonniere Deformity of the Finger: REPORT OF TWO CASES.. The Journal of Bone and Joint Surgery. American Volume. 1965.

[11] Thumb boutonnière deformity without rheumatoid arthritis or trauma. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417704610

[12] Assessment of the ligamentous stress distribution in the pathomechanics of the boutonniere deformity through a computational 3D model. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06329-3

[13] TREATMENT OF THE CHRONIC BOUTONNIERE DEFORMITY BY EXTENSOR TENOTOMY. Hand Clinics. 1995. DOI: 10.1016/s0749-0712(21)00065-2

[14] Closed Soft Tissue Extensor Mechanism Injuries (Mallet, Boutonniere, and Sagittal Band). The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.11.018

[15] Biomechanics of the Acute Boutonniere Deformity. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.07.011

[16] Anterior dislocation of the proximal interphalangeal joint. A cause of rupture of the central slip of the extensor mechanism.. The Journal of bone and joint surgery. American volume. 1970.

[17] Treating the Proximal Interphalangeal Joint in Swan Neck and Boutonniere Deformities. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.12.006

[18] Boutonnière and Pulley Rupture in Elite Athletes. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.044

[20] Nonoperative treatment of the Boutonniere deformity: Is there a difference in outcomes?. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2025.02.013

[23] The Use of Relative Motion Flexion Orthoses for Chronic Boutonniere Deformity. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2022.08.007

[24] Longitudinal Tear of the Central Slip Causing Painful and Unusual Snapping of the Finger: A Case Report. HAND. 2022. DOI: 10.1177/15589447221081876

[25] Biomechanics of the Acute Boutonniere Deformity. The Journal of Hand Surgery. 2012. DOI: 10.1016/s0363-5023(12)60014-8

[26] Redistribution of Forces in the Correction of the Boutonniere Deformity.. The Journal of Bone and Joint Surgery. American Volume. 1967.

[28] A Modification Of Elson's Test For The Diagnosis Of An Acute Extensor Central Slip Injury. The British Journal of Hand Therapy. 2006. DOI: 10.1177/175899830601100402

[31] Irreducible volar dislocation of the proximal interphalangeal joint of a finger caused by interposition of the intact central slip. The Journal of Bone & Joint Surgery. 1978. DOI: 10.2106/00004623-197860010-00023

[35] Successful conservative treatment outcomes and clinical characteristics of congenital hypoplasia of the extensor tendon central slip. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416676410