Boutonniere Deformity

Boutonniere Deformity

Boutonniere Deformity (BD) is a tendon injury that usually prevents complete straightening of the fingers. Typical picture is bent middle joint of injured finger  while fingertip is bent backward. The deformity may progress which may eventually lead to permanent deformity and impaired functioning.^[1]

Epidemiology

A study of 43 of 71 patients treated in an emergency department diagnosed of jammed or sprained finger over a 14 month time showed that 2 of the 43 patients went on to develop a BD. Up to half or 50% of patients with rheumatoid arthritis are approximated to develop a boutonniere deformity in at least 1 digit. ^[2]
 

Causes

Generally, boutonniere deformity is brought about by a forceful blow to the finger. Other causes include diseases like arthritis or a cut on the top of the finger which may sever the central slip from its connection to the bone. ^[1] The small openings resemble buttonholes, and provide the origin for the name “Boutonnière.”^[3] The condition can be apparent at born in some individuals.^[4]
 

Signs and Symptoms

Symptoms of boutonnière deformity can develop at once following an injury to the finger or may be delayed and only manifest 7 to 21 days after the trauma. The person may notice that the finger at the middle joint could not be set straight while the fingertip could not be bent. Additionally, there may be swelling and pain.^[1]
 

Diagnosis 

Diagnosis is made through history and physical examination. X-rays are necessary to see if there is an associated avulsion fracture, since the recommended treatment may depend on the x-ray result.^[5]
 

Treatment

Usually, patients receive conservative treatment by splinting initially.^[2] It is essential to wear the splint for the recommended length of time which is usually 6 weeks for a young patient and 3 weeks for an elderly patient. To improve strength and flexibility of fingers, stretching exercise is often recommended.^[1] Those needing surgical intervention at the outset include open injuries, unreducible volar dislocation of the proximal interphalangeal joint, and displaced avulsion fractures of the dorsal base of the middle phalanx. If splinting techniques fail, surgery may be necessary.^[2]

 References:

1. http://orthoinfo.aaos.org/topic.cfm?topic=a00004
2. http://emedicine.medscape.com/article/1238095-overview#a0199
3. http://www.dynasplint.com/glossary/term/boutonniere-deformity/
4. http://www.eatonhand.com/hw/hw004.htm
5. http://www.orthogate.org/patient-education/hand/boutonniere-deformity-of-the-finger.html

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