Nonoperative treatment of the Boutonniere deformity: Is there a difference in outcomes?

Abstract

Background: The optimal nonoperative treatment for a Boutonniere deformity remains controversial.

Purpose: We aimed to evaluate the effect of nonsurgical treatment methods on finger motion for Boutonniere deformities.

Study design: Retrospective cohort study.

Methods: Conservative treatments included hand therapy, orthotic wear, and home finger exercises. Digit range of motion (ROM) and injury characteristics also were evaluated. Based upon active ROM at the proximal interphalangeal joint, digits were graded as Poor, Good, or Excellent, and then a change in ROM grade was calculated from pre- to post-treatment for each digit. Standard statistical analyses were performed to evaluate for significant influences on changes in ROM grade.

Results: One hundred and eleven digits (106 patients) were included. Traumatic injury was most common (87.4%). All digits but one received an orthotic. Average treatment and follow-up time was 14.6 weeks. Pre-treatment, there were 63 Poor, 29 Good, and 19 Excellent digits, with average total arc of motion of 47.3, 78.4, 84.2°, respectively (p < 0.01). Post-treatment, there were 28 Poor, 34 Good, and 49 Excellent digits, with average total arc of motion of 57.0, 81.4, 98.4°, respectively (p < 0.01). Forty nine digits had no change in ROM grade post-treatment, 37 had one grade of improvement, 18 had two grades of improvement, and seven had one grade worse. Across these four cohorts, digits that began treatment within 6 weeks of injury had the greatest amount of improvement (p = 0.02), whereas deformity from inflammatory arthritis were less likely to respond to treatment (p = 0.045). Otherwise, there were no differences in type or length of conservative treatment across cohorts (p > 0.1).

Conclusions: Improvement in digit ROM was associated with initiation of treatment within 6 weeks, but not with any particular type or length of conservative treatment. One to two grades of ROM improvement can be achieved, although deformity can persist even after dedicated conservative management.