Correction of swan-neck and boutonnière deformities.

Rheumatoid arthritis frequently affecting the hand is a progressive and disabling illness. The delicate and precis digital motor mechanism is frequently affected by this disease and the consequences are devastating, with marked functional impairment. This paper discusses two of the most frequent digital deformities: the swan-neck and boutonniere. The pathophysiology, and classification according to the evolution grades of these deformities are presented. Practical application of various surgical techniques, each worked out and proven over 30 years of experience and a great number of cases treated is described. Unfortunately, the results are still modest in relation to the destruction created by this progressive pathology. However, we rely on certain modern techniques and thus obtain considerable functional improvement. The elastomer or silicone rubber prosthesis, implanted with sophisticated techniques and delicate handling of tissues is one of most significant innovations.