Traumatic Buttonhole Deformity of the Thumb

Soo-Min Cha; Hyun-Dae Shin; Kyung-Cheon Kim

doi:10.4055/jkoa.2012.47.6.473

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Cha, Shin, and Kim: Traumatic Buttonhole Deformity of the Thumb

Case Report

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2012; 47(6): 473-477.

Published online: 28 December 2012

DOI: https://doi.org/10.4055/jkoa.2012.47.6.473

Traumatic Buttonhole Deformity of the Thumb

Soo-Min Cha, M.D., Hyun-Dae Shin, M.D., Ph.D., Kyung-Cheon Kim, M.D., Ph.D.

Department of Orthopaedic Surgery, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, Korea.

Correspondence to: Hyun-Dae Shin, M.D., Ph.D. Research Institute for Medical Sciences, Chungnam National University College of Medicine, 266, Munhwa-ro, Jung-gu, Daejeon 301-747, Korea. TEL: +82-42-280-7349, FAX: +82-42-252-7098, hyunsd@cnu.ac.kr

Received 18 September 2012 Revised 24 October 2012 Accepted 9 November 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: thumb, buttonhole deformity, surgical procedures

Figures and Tables

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.

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.

References

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