Boutonniere deformity : grade 4
Presentation:
A 30 year-old male with clinical apparent post-traumatic Boutonniere deformity: hyperflexion of the PIP and hyperextension of the DIP of the right 5th finger. The injury occurred during basketball. Further examination showed marked flexion contracture and an inability to passively extend the PIP joint, corresponding to Stage 4.
Patient Data:
Hyperflexion of the PIP and hyperextension of the DIP
Hyperflexion of the PIP and hyperextension of the DIP. No avulsion fracture (David Sloane radiographer, John Osborne radiologist).Loading more images...
Rupture of the central extensor tendon slip
A fluid filled gap is shown between the thickened, retracted central slip of the extensor tendon and its insertion site at the base of the middle phalanx. The tendon was retracted approximately 1cm from its insertion site.Case Discussion:
The patient injured his right 5th finger while playing basketball 2 weeks prior. By the time he had presented to our department he had advanced flexion contracture and no passive extension indicating a grade 4 deformity and the likelihood of a poor outcome.
Ultrasound showed complete rupture of the central extensor tendon slip resulted in a marked Boutonniere deformity with wide separation of the lateral slips. There was tearing of the collateral ligaments and probable rupture of the PIP palmar plate.
There was no evidence of avulsion fracture on ultrasound or X-ray.
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