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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Posttraumatic boutonnière deformity of the thumb: A case report

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  • presenting/speaker Antonio García-Jiménez - SSIBE - Hospital de Palamós, Palamós, Spain
  • Bernardo Uran - SSIBE - Hospital de Palamós, Palamós, Spain
  • Javier Ochoa - SSIBE - Hospital de Palamós, Palamós, Spain

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-58

doi: 10.3205/19ifssh0281, urn:nbn:de:0183-19ifssh02818

Published: February 6, 2020

© 2020 García-Jiménez et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

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Objectives/Interrogation: Boutonnière deformity of the thumb is common in rheumatoid arthritis, but it is very rare when it is caused by a traumatism in a non-rheumatoid patient.

We present a case report of a patient who developed a boutonnière deformity of the thumb after a closed injury.

Methods: A 27-year-old women, massage therapist, hit her right hand (dominant extremity) with a box she was carrying. She presented 2 months after the injury, and complained of pain and deficit of extension of the metacarpophalangeal (MCP) joint. Radiographs of the thumb showed normality of the MCP joint. Magnetic ressonance showed integrity of the extensor pollicis longus (EPL) tendon and disruption of the dorsal capsule.

Surgical findings included disruption of the dorsal capsule, partial detachement of the extensor pollicis brevis (EPB) tendon and ulnar luxation of the EPL tendon. The partial injury of the EPB tendon was sutured, as well as the dorsal capsule, with reduction of the EPL luxation. The MCP joint was immobilized with a cast for 4 weeks.

Results and Conclusions: After the immobilization, range of motion was started, but unfortunately only two weeks after she returned to the emergency room with boutonnière deformity of the operated thumb. She was reoperated, finding this time a new disruption of the dorsal capsule, an ulnar subluxation of the EPL tendon and integrity of the EPB tendon. We re-sutured the dorsal capsule, with reduction of the EPL tendon, and immobilized the MCP joint with a cast for 6 weeks. After that period of time, we started range of motion. At one year of follow-up, she complains of partial deficit of extention with normal flexion and reduced key pinch strength compared with contralateral hand.

Boutonnière deformity of the hand is an uncommon injury that should be recognized. There are few cases in literature, but we can observed that the results are worse when there is a long delay between the lesion and the surgery, and it is observed in the case report we present.