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Boutonniere Deformity
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Contents
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
Etiology
- Occurs as a result of a Central Slip Extensor Tendon Injury
- Results in flexion contracture of PIPJ and hyperextension of DIPJ
- Acute
- Direct laceration to extensor tendon
- Jammed finger
- Chronic
- Rheumatoid Arthritis
- Burns
Anatomy
Risk Factors
- Systemic
Differential Diagnosis
- Fractures
- Dislocations
- Tendinopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
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
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
- https://www.sportsmedreview.com/blog/review-of-the-traumatic-boutonniere-deformity/
References
- ↑ Image courtesy of osmifw.com, "Boutonnière Deformity
- ↑ Image courtesy of verywellhealth.com, "Boutonniere Deformity"
- ↑ Contributed by Dr.Rebecca Flores.
- ↑ 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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