finger flexion deformity - correction - capener spring  splint - serial casting 

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091982/
    1. spring splint or serial asting 
    2. serial casting weekly or three days 
    3. results good 
      1. flowers and le stayo 1994 
  2. https://handsurgery.org/multimedia/files/preCourse/relative%20motion%20splint%20Merritt.pdf 
    1. Relative Motion Splint: Active Motion After Extensor Tendon Injury and Repai
      1. Wyndell H. Merritt, MD
    2. When an injured tendon is placed in 15 to 20 less relative motion than adjacent tendons from a shared muscle (extensor or flexor), it will experience markedly less force than adjacent tendons, regardless of the position from full extension to full flexion (minus the 15 to 20 difference at the MCP joint). With long extensor repair in zones IV to VII, all extensors function like the single unit extensor digitorum communis muscle. Independent extensors recover equally well as the common extensors when placed in 15 to 20 greater MCP extension than the adjacent digits  Fig. 1). This concept is also effective in reducing tension across sagittal band ruptures and side-to-side tendon transfers in caput ulnae syndrome. We call this the relative motion extensor splint
    3. In boutonniere deformity, the lumbricals have 4 times the excursion of the more powerful interossei, and therefore are the principal extensors of the inter-phalangeal (IP) joints The lumbricals arise from the flexor digitorum profundus tendons that come from a single motor unit. Therefore, placing the injured extensor hood digit into 15 to 20 greater MCP flexion relative to adjacent digits places laxity in that profundus tendon, which relaxes that lumbrical from its downward pull while increasing tension on the extensor hood, encouraging dorsal repositioning, regardless of whether the patient fully flexes or extends (minus the 15 to 20 MCP extension compare with its neighboring digits). We call this a relative motion flexor splint
    4. It is easily demonstrated in the cadaver by creating a large boutonniere deformity and
      placing a cotton tip applicator or tongue blade over the proximal phalanx of the operated digit and beneath the adjacent digits, then pulling on the common extensor muscles (see Videos 1 and 2 available on the Journal's Web site at http://www.jhandsurg.org). It can
      also be demonstrated in a patient with an acute closed boutonniere deformity and supple joint 
    5. Boutonniere deformity zone III
      1. Chronic boutonniere has been a surgical conundrum, with poor results reported, especially in older patients and those with fixed flexion contractures.
      2. Once serial casting achieves maximum PIP extension, if it is better than 30, the author accepts this and uses relative motion flexor splinting full-time for 3 months. This splint is compatible with active use of the hand, permitting full flexion, and patients are therefore compliant. At the end of 3 months, the degree of improved PIP extension has been maintained, with follow-up as long as 3 years, in the author experience. It is always preferable to obtain andmaintain full extension, but this researcher has been pleasantly surprised to find that less than full extension can be preserved using the relative motion flexorsplint.

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