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Boutonniere Deformity

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Other Names

  • Buttonhole deformity
  • Boutonniere Deformity (BD)

Background

  • This page refers to a Boutonniere Deformity, which is a zone 3 central slip injury

History

  • Note that 'Boutonniere' is French for buttonhole

Epidemiology

Pathophysiology

Illustration of Boutonniere Deformity[1]
  • General
    • Zone 3 injury to the central slip
    • Resulting in a pathologic flexion at the PIPJ and hyperextension at the DIPJ

Etiology

Anatomy

Risk Factors

Differential Diagnosis

Clinical Features

Clinical Example of Boutonniere Deformity[2]
  • History
    • Important to clarify etiology
    • Is it acute, subacute or chronic?
  • Physical Exam: Physical Examination Hand
    • The resting position of the finger may be PIPJ in flexion with DIPJ in extension
  • Special Tests
    • Elson's Test can help confirm central slip injury
    • Boyes Test is also useful to evaluate extensor tendon integrity

Evaluation

Boutonniere Deformity of the 5th digit seen on lateral view (etiology unknown)[3]
  • Standard Radiographs Hand
    • Typically satisfactory to evaluate
    • Can evaluate degree of flexion (PIPJ) and hyperextension (DIPJ)
    • Also can help clarify etiology

Classification

Burton Classification

  • Stage 1: BD with supple, passively correctable joint[4]
  • Stage 2: BD with fixed contracture, contracted lateral bands, PIPJ maintained
  • Stage 3: BD with fixed deformity, contracture of lateral bands, volar plate and collateral ligaments; PIPJ with intra-articular fibrosis
  • Stage 4: BD with fixed deformity, contractures of lateral bands, volar plate and collateral ligaments; PIPJ with intra-articular fibrosis and radiographically evident degenerative arthritis

Management

Acute, Nonoperative

  • Extension splinting of PIPJ for 4-6 weeks
  • Encourage active DIPJ extension and flexion in splint
  • Indications
    • absence of avulsion fracture
    • Small avulsion fracture, nondisplaced

Acute, Operative

  • Indications
    • Avulsion fracture of middle phalanx
    • Open injury

Chronic, Nonoperative

  • Most cases can be managed nonoperatively

Chronic, Operative

  • Rheumatoid patients
  • Painful, still and arthritic joint

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play/ Work

  • Needs to be updated

Complications and Prognosis

Prognosis

  • Needs to be updated

Complications

  • Functional debilitation
  • Chronic Pain

See Also

External

References

  1. ↑ Image courtesy of osmifw.com, "Boutonnière Deformity
  2. ↑ Image courtesy of verywellhealth.com, "Boutonniere Deformity"
  3. ↑ Contributed by Dr.Rebecca Flores.
  4. ↑ McKeon, Kathleen E., and Donald H. Lee. "Posttraumatic boutonniere and swan neck deformities." JAAOS-Journal of the American Academy of Orthopaedic Surgeons 23.10 (2015): 623-632.
Created by:
John Kiel on 18 June 2019 23:23:34
Authors:
Last edited:
16 October 2022 00:18:26
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