J Korean Orthop Assoc.  2012 Dec;47(6):473-477. 10.4055/jkoa.2012.47.6.473.

Traumatic Buttonhole Deformity of the Thumb

• Cha SM
• Shin HD
• Kim KC

• KMID: 2185313
• DOI: http://doi.org/10.4055/jkoa.2012.47.6.473

Abstract

Traumatic buttonhole deformity is very rare. In rheumatoid arthritis, synovitis of the metacarpophalangeal joint stretches the dorsal capsule and as a result the extensor pollicis brevis gradually becomes attenuated. Also, the extensor pollicis longus progressively subluxed ulnar and volarward. However, in the cases derived from trauma, combination injuries to the dorsoradial capsule, extensor pollicis insertion and ulnar subluxation of extensor pollicis longus, are essential. Authors experienced the cases of two traumatic buttonhole deformities, and performed operative treatment. In one case, the injured extensor pollicis brevis insertion was detached from the capsule and hood. We advanced and reattached the extensor pollicis brevis to the capsule, after imbricating the capsule and established the normal alignment of the extensor pollicis longus. In the other case, the extensor pollicis brevis insertion was maintained, but the capsule and extensor pollicis longus were severely attenuated. At the 12-month follow-up, the clinical results were satisfactory in both cases.

Keyword

thumb; buttonhole deformity; surgical procedures

MeSH Terms

Arthritis, Rheumatoid
Congenital Abnormalities
Follow-Up Studies
Metacarpophalangeal Joint
Synovitis
Thumb

Figure

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  Figure 1 (A) Appearance of the buttonhole deformities. (B) After several flexion and extension movements of the thumb, the subluxed extensor pollicis longus was reduced spontaneously and the deformity was temporarily relieved. (C) Grossly, there was a torn, attenuated capsule at the dorsoradial aspect of the metacarpophalangeal joint. (D) In addition, a very thin remnant of the extensor pollicis brevis was attached to the base of the proximal phalanx. (E) First, the attenuated capsule was imbricated after debridement. (F) The extensor pollicis brevis was reattached at the distal portion of the capsule and the periosteum of the proximal phalanx. (G) Finally, the extensor pollicis longus was aligned in its own anatomical position, by suturing the sheath at the adjacent soft tissue.

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  Figure 2 (A) Preoperative photograph of the left thumb. The patient was asked to extend the thumb fully, but this was difficult due to pain at the metacarpophalangeal joint. (B, C) At twelve months postoperatively, the deformity was corrected and the patient was satisfied.

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