PIPJ Boutonniere Deformity - Serial Casting

The most effective means of reducing a fixed flexion deformity is through the use of serial casting. The cast is fabricated, bearing in mind the necessity for a 3 point pressure to be applied, using biomechanical principles, whereby the MCPJ is stabilized by a volar slab that extends into the palm and through the use of levers. The proximal phalanx and metacarpal of the corresponding finger form 1 lever and the middle and distal phalanx forms a second lever. The dorsum of the PIPJ remains free from pressure. A circumferential layer is then applied to the finger while the 2 levers are passively extended within the cast to correct the fixed flexion deformity of the PIPJ as much as possible. Once the POP sets, the finger remains in the cast for 5 days. It is then removed using cold water.