A boutonniere deformity is a delayed complication that is rarely evident on presentation. It should be suspected in all volar PIP dislocations, and it typically results from a direct blow to the finger from activities like ball sports or martial arts. If patients have tenderness at the PIP, they should be evaluated for a possible central slip injury with a modified Elson test. If a central slip is suspected, these patients should have the PIP splinted, leaving the MCP and DIP free to move. Extension and flexion of the DIP should be encouraged. These patients also require urgent referral to a hand surgeon for evaluation and possible surgical repair.

 

boutonniere deformity

Boutonnière finger

boutonnière injury

buttonhole injury

Central slip

central slip rupture

Elson test

extensor mechanism of the finger

extensor tendon

injured PIP joint