Daily Bolus of LR: Boutonniere Deformity

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April 6, 2011 by dailybolusoflr

Boutonniere Deformity

Laceration of the central slip of the extensor tendon at the PIP joint (proximal interphalyngeal joint)

This leads the lateral bands of the extensor tendon to slip volar to the axis of the PIP joint paradoxically becoming flexors of the joint (the PIP)

As the extensor tendons slip laterally they also shorten and wind up hyperextending the DIP joint (distal interphalyngeal joint)

The finger winds up with an abnormal appearance, which can be seen here

In the setting of an acute injury to the extensor tendon, splint the PIP in extension and refer to hand surgeon for operative repair

If patients come in days to weeks after the injury with the deformity, you can attempt to splint their PIP in extension, but do not force the digit if it is hard to move. Operative repair should be attempted to attempt to regain normal alignment and function

Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions

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