Imaging Studies

A boutonnière (buttonhole) deformity (BD) can be assessed by means of plain radiography (see the image below). The lateral radiograph of the affected digit can define the degree of hyperextension at the distal interphalangeal (DIP) joint. Furthermore, radiographs may identify any osseous abnormality.

Radiographic evidence of boutonnière deformities. Image courtesy of Radiopaedia.org; case by Dr Aditya Shetty (http://radiopaedia.org/cases/rheumatoid-arthritis-13).

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Treatment & Management

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Media Gallery

Lateral view of relevant finger anatomy.
Normal lateral band location, dorsal to axis of rotation of proximal interphalangeal joint.
After central slip disruption, lateral bands migrate volar to axis of rotation of proximal interphalangeal joint.
Boutonnière deformity. Image courtesy of David Bozentka, MD, University of Pennsylvania School of Medicine, published by Medscape (Late Reconstruction of Flexor and Extensor Tendon Injuries at http://www.medscape.com/viewarticle/717388).
Radiographic evidence of boutonnière deformities. Image courtesy of Radiopaedia.org; case by Dr Aditya Shetty (http://radiopaedia.org/cases/rheumatoid-arthritis-13).
Bunnell safety-pin splint.
Boutonnière deformity.

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Author

Wayne Reizner, MD Resident Physician, Department of Orthopedic Surgery, Mount Sinai St Luke’s-Roosevelt

Disclosure: Nothing to disclose.

Coauthor(s)

David A Forsh, MD Chief, Orthopedic Trauma Surgery, Assistant Professor, Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai

David A Forsh, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, AO North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Thomas R Hunt III, MD Professor and Chairman, Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine

Thomas R Hunt III, MD is a member of the following medical societies: American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, Southern Orthopaedic Association, AO Foundation, American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Society for Surgery of the Hand, Mid-America Orthopaedic Association

Disclosure: Received royalty from Tornier for independent contractor; Received ownership interest from Tornier for none; Received royalty from Lippincott for independent contractor.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society, Florida Medical Association, Florida Orthopaedic Society

Disclosure: Nothing to disclose.

Additional Contributors

Michael S Clarke, MD Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.