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Chronic injury to what anatomic structure can lead to a boutonnière deformity of the finger?
terminal extensor tendon
flexor digitorum profundis tendon insertion
central slip of the extensor tendon
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Rupture of the central slip of the extensor tendon and subsequent subluxation of the lateral bands leads to a boutonnière deformity, which is characterized by PIP flexion and DIP extension. Central slip injuries can be caused by a laceration or traumatic avulsion. In the listed reference, Imatami et al treated a series of central slip injuries associated with attachment fractures successfully with ORIF. As stated by Tuttle et al, rupture of the terminal extensor tendon leads to a mallet finger. Sagittal band injury can lead to subluxation of the extensor tendon at the level of the MCP joint. Chronic volar plate injuries can lead to swan neck deformities. Avulsion of the FDP insertion leads to a jersey finger. Illustrations A and B are a clinical photograph and anatomic diagram of a boutonneire deformity.
Tuttle HG, Olvey SP, Stern PJ
Clin. Orthop. Relat. Res.. 2006 Apr;445:157-68. PMID: 16601414 (Link to Abstract)
Imatami J, Hashizume H, Wake H, Morito Y, Inoue H.
J Hand Surg Br. 1997 Feb;22(1):107-9. PMID: 9061541 (Link to Abstract)
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A 54-year-old female presents with a hand deformity. A surgical procedure is being considered that relocates the lateral bands dorsally to counteract the pathophysiology of the deformity. Which of the following deformities does this patient most likely have?
Boutonneire finger deformity
Lumbrical plus finger deformity
Mallet finger deformity
Jersey finger deformity
Swan neck finger defomity
Boutonniere deformity is characterized with the PIP in flexion and the DIP in hyperextension as shown in Illustration A. It is caused by central slip rupture or attenuation (secondary to capsular distention, e.g., rheumatoid arthritis), laceration, or traumatic disruption. Volar subluxation of the lateral bands due to incompetence or disruption of the triangular ligaments leads to increased deformity as the lateral bands become flexors of the PIP. Relocation of the lateral bands to their original dorsal position to counteract the pathophysiology of the deformity is an option for patients that have an approximately 40 degree active flexion contracture but full passive extension.
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Video showing Elson's test for Boutonniere deformity
Educational video describing the Boutonniere deformity of the fingers, including...