Boutonniere deformity: grade 4

Case contributed by Brendan Cullinane


Clinically 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

Age: 30 years
Gender: Male

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).


See below

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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Case information

rID: 12930
Published: 4th Feb 2011
Last edited: 1st Jun 2016
Inclusion in quiz mode: Excluded

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