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

Traumatic Buttonhole Deformity of the Thumb

  • 1Department of Orthopaedic Surgery, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea. hyunsd@cnu.ac.kr


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.


thumb; buttonhole deformity; surgical procedures
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