Boutonniere Deformity: A Review of Considerations before Treatment and Current Treatment Options

Abstract

Central slip injury is a common occurrence in hand trauma. When the base of the middle phalanx, which is the contact part of the central tendon, is weakened or damaged, extension lag or restriction would be found in the proximal interphalangeal (PIP) joint and the distal interphalangeal joint becomes hyperextended, presenting buttonhole or boutonniere deformation. Buttonhole deformation has limited cases that a hand surgeon can experience, and there is still no clear guideline for treatment, so treatment tends to depend on the knowledge and experience of the treating doctor. In this review, the factors to be considered in determining the treatment of boutonniere deformity are discussed, and nonsurgical or surgical treatment is considered. Treatment of the PIP joint in boutonniere deformity is a difficult task. Understanding the cause of the deformity, the time point and the stage of deformity, the relationship to the biomechanical changes in adjacent joints, the patient’s functional limitations, and the condition of the joint will improve treatment decisions and outcomes. Based on these considerations, an appropriate treatment should be chosen among nonsurgical or surgical treatments. Various surgical options were introduced but none of method guarantee the optimal outcome. Sufficient understanding of deformity and sufficient consultation and cooperation with the patient regarding the treatment process, outcome, and rehabilitation are necessary.