J Korean Orthop Assoc.  2012 Dec;47(6):473-477. 10.4055/jkoa.2012.47.6.473.

Traumatic Buttonhole Deformity of the Thumb

• Cha SM
• Shin HD
• Kim KC

• KMID: 2185313
• DOI: http://doi.org/10.4055/jkoa.2012.47.6.473

Abstract

Traumatic buttonhole deformity is very rare. In rheumatoid arthritis, synovitis of the metacarpophalangeal joint stretches the dorsal capsule and as a result the extensor pollicis brevis gradually becomes attenuated. Also, the extensor pollicis longus progressively subluxed ulnar and volarward. However, in the cases derived from trauma, combination injuries to the dorsoradial capsule, extensor pollicis insertion and ulnar subluxation of extensor pollicis longus, are essential. Authors experienced the cases of two traumatic buttonhole deformities, and performed operative treatment. In one case, the injured extensor pollicis brevis insertion was detached from the capsule and hood. We advanced and reattached the extensor pollicis brevis to the capsule, after imbricating the capsule and established the normal alignment of the extensor pollicis longus. In the other case, the extensor pollicis brevis insertion was maintained, but the capsule and extensor pollicis longus were severely attenuated. At the 12-month follow-up, the clinical results were satisfactory in both cases.

Keyword

thumb; buttonhole deformity; surgical procedures

MeSH Terms

Arthritis, Rheumatoid
Congenital Abnormalities
Follow-Up Studies
Metacarpophalangeal Joint
Synovitis
Thumb

Reference

1. Nalebuff EA, Potter TA. Rheumatoid involvement of tendon and tendon sheaths in the hand. Clin Orthop Relat Res. 1968. 59:147–159.

2. Nalebuff EA. Diagnosis, classification and management of rheumatoid thumb deformities. Bull Hosp Joint Dis. 1968. 29:119–137.

3. Krause JO, Manske PR, Mirly HL, Szerzinski J. Isolated injuries to the dorsoradial capsule of the thumb metacarpophalangeal joint. J Hand Surg Am. 1996. 21:428–433.

4. Churchill M, Citron N. Isolated subluxation of the extensor pollicis longus tendon. A cause of 'boutonnière' deformity of the thumb. J Hand Surg Br. 1997. 22:790–792.

5. Terrono A, Millender L, Nalebuff E. Boutonniere rheumatoid thumb deformity. J Hand Surg Am. 1990. 15:999–1003.

6. Failla JM. Combined extensor pollicis brevis and radial collateral ligament injury: three case reports. J Hand Surg Am. 1996. 21:434–437.

7. Brunelli GA, Brunelli GR. Anatomy of the extensor pollicis brevis muscle. J Hand Surg Br. 1992. 17:267–269.

8. Cardon LJ, Toh S, Tsubo K. Traumatic boutonniere deformity of the thumb. J Hand Surg Br. 2000. 25:505–508.