When a Boutonnière deformity of the finger is encountered and volar subluxation of the lateral bands cannot be corrected by conservative treatment, different surgical techniques have been described in the literatures. To restore physiologic dorsal-volar translation of the lateral bands is the ideal goal for both finger extension and flexion. Not every surgical technique achieves the goal.
Aim:
A novel repair technique, lambda (λ) repair, is introduced for functional reconstruction of the extensor mechanism.
Material & Methods:
The method involves an end-to-side tenorrhaphy of the lateral bands resembling the Greek letter λ. Cadaveric model was created to test the repair technique for a Boutonnière deformity. Patients who underwent a λ repair were retrospectively evaluated with pre- and postoperative measurements of PIP joint movement.
Results:
In cadaveric model, the lateral bands repaired by λ technique were able to glide volarly and dorsally while flexion and extension of the digit. Clinically, we included 7 fingers of 6 patients (4 male, 2 female, median age 38.5 years) with a median follow-up period of 9 months. Six fingers underwent λ repair for isolated Boutonnière deformities and one finger received a vascularized free toe transfer combined with a λ repair. The preoperative average PIP joint extension lag or deficit was 28.75°and could be reduced to 15°. Preoperative average PIP joint active flexion was 60° which was also improved to 88.75°. No complications were observed.
Conclusions:
The λ repair is a new tool in the reconstruction of Boutonnière deformity, further expanding the armamentarium of hand surgeons.