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Has Anyone Developed Boutonniere Deformity Following Treatment?
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07/02/19 22:13
rockinroller 
07/02/19 22:13
rockinroller 
Has Anyone Developed Boutonniere Deformity Following Treatment?

Here I was, all excited about having a useful little finger last year after being treated with Xiaflex. Then, about 9 months later I started noticing that little finger assuming an unusual "ski jump slope" shape, with the pre-knuckle area somewhat normal compared to the adjoining fingers, but at the first joint halfway up the finger and forward to the nail, the shape takes a dramatic slope downward, then dramatically up again just before the nail. I've researched this condition ("Boutonniere Deformity") and apparently it's due to trauma and not a heredity-based, age-related or necessarily associated with DD. I know that I've had no "trauma" (i.e. slamming my finger into something, or having been hit, etc) to that finger and the only inordinate contact has been with my hand surgeon who treated it with Xiaflex. I am wondering if any of you DD patients out there have developed this deformity as well, or if I should possibly investigate this as some sort of malpractice by the doctor in connection with the treatment I received for Dupuytrens. See pic attached.

Edited 07/02/19 22:16

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boutonniere deformity.jpg boutonniere deformity.jpg (4x)

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07/02/19 23:33
BRIANB 
07/02/19 23:33
BRIANB 
Re: Has Anyone Developed Boutonniere Deformity Following Treatment?

Have you worn a night brace / splint post your procedure? If not, perhaps wearing the appropriate one would help.
Good luck ..

07/03/19 08:24
spanishbuddha 

Administrator

07/03/19 08:24
spanishbuddha 

Administrator

Re: Has Anyone Developed Boutonniere Deformity Following Treatment?

I would suspect the collagenase. It pops up in medical reports although is not a listed side effect. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4778900/. But 9 months later is a bit of a stretch to link the two. Some Drs are using collagenase, off label, to treat a boutonnière but as Brian says I think a splint is more conventional as first pass conservative treatment, before surgery.

07/04/19 16:45
rockinroller 
07/04/19 16:45
rockinroller 
Re: Has Anyone Developed Boutonniere Deformity Following Treatment?

I stopped wearing the splint about 2 months following the Xiaflex procedure. I investigated a number of studies involving use of a post-procedure splint, its efficacy, etc and it seemed there was a substantial amount of conclusions that its use did nothing to either slow the return of DD, or keep the finger straight (as if DD has a "mind" of its own!). Whether that splint would have assisted in not allowing the Boutonniere Deformity to present will not be known, I guess. In retrospect, I wish I had continued the splint, although it contributed to an increase in my sleep disruption--a condition I've battled anyway, for years.

07/04/19 18:57
mikes 
07/04/19 18:57
mikes 
Re: Has Anyone Developed Boutonniere Deformity Following Treatment?

After NA, I continued to splint as advised nightly for several years followed by a gradual tapering off. For me, the splint kept recurrence away and actually somehow contributed to further straightening over time.

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Treatment   malpractice   Boutonniere   disruption--a   heredity-based   conventional   substantial   investigated   Deformity   boutonnière   contributed   post-procedure   Developed   dramatically   straightening   conclusions   age-related   collagenase   conservative   Following