Extensor tendon injuries at the proximal interphalangeal joint.

From the prior discussion, it should be apparent that the multitude of operative procedures reflects the complexity inherent in the extensor mechanism and the often unpredictable outcome of operative intervention. Large studies with detailed analysis of data are few. Despite this, several themes are apparent and need to be respected. The chronic boutonniere deformity reflects long-term derangement with secondary compensation of the extensor mechanism. The surgeons rendering treatment must have a thorough appreciation of normal anatomy as well as an understanding of the evolving pathomechanics. Both physician and patient must be committed to the need for long-term treatment of this disability. The literature leaves no doubt that surgical intervention is best initiated after the attainment of full passive PIP extension. Finally, even in the chronic situation, long-term splinting and exercises may be successful and both obviate surgery and result in a superior outcome.