Boutonniere Deformity - Hand - Orthobullets

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• characterized by PIP flexion and DIP extension.

• Diagnosis is made clinically with PIP flexion and DIP extension of a digit with presence of a positive Elson test.

• Treatment of acute injuries involves splinting of the PIP joint with operative management reserved for chronic, symptomatic injuries.

• common in rheumatoid patients

• Up to 50% of patients with rheumatoid arthritis develop a boutonniere deformity in at least one digit

• caused by rupture of the central slip over PIP joint from

• laceration traumatic avulsion (jammed finger) capsular distension in rheumatoid arthritis

• pathoanatomic sequence includes

• rupture of central slip

• attenuation of triangular

• palmar migration of collateral bands and lateral bands

• bone deformity

• injury involves all three phalanges

• the middle phalanx flexes on the proximal phalanx at the PIP joint

• the distal phalanx is hyperextended relative to the middle phalanx at the DIP joint

• rheumatoid arthritis

• refers to PIP joint flexion contracture in the absence of DIP extension

• causes the extrinsic extension mechanism from the EDC to be lost

• prevents extension at the PIP joint

• causes intrinsic muscles of the hand (lumbricals) to act as flexors at the PIP joint