Aggarwal Sarthak, Stepan Jeffrey G
University of Chicago, Pritzker School of Medicine, Chicago, Illinois, United States.
Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, Illinois, United States.
J Orthop Case Rep. 2025 Apr;15(4):21-25. doi: 10.13107/jocr.2025.v15.i04.5430.
Thumb boutonniere deformity, commonly associated with autoimmune arthropathies, presents as metacarpophalangeal (MCP) joint flexion and interphalangeal (IP) joint hyperextension. Literature guiding management remains incomplete and out-of-date, and it largely addresses low-demand populations. IP joint dislocation is a particularly severe presentation that notably has only been reported once before.
We report a rare case of severe Type 1 thumb boutonniere deformity with IP joint dislocation in a 42-year-old, high-demand female patient with a history of autoimmune diseases. We describe the successful treatment of this severe thumb deformity using MCP arthrodesis and temporary IP joint pinning, which resulted in preserved function and stability. At 1-year follow-up, the patient reported good function of the thumb with no instances of IP joint dislocation.
In prior literature, MCP arthroplasty with IP arthrodesis has been recommended in severe thumb boutonniere deformities, but this may be inappropriate for younger, higher-demand patients. Surgeons should obtain a comprehensive understanding of each patient's anatomy and functional goals to best develop treatment strategies. The success of MCP arthrodesis and temporary IP joint pinning in this population is evidenced by the maintained IP joint range of motion and lack of dislocation with pinch and grip activities at 1 year follow-up.
拇指纽扣畸形通常与自身免疫性关节病相关，表现为掌指（MCP）关节屈曲和指间（IP）关节过伸。指导治疗的文献仍然不完整且过时，并且主要针对需求较低的人群。IP关节脱位是一种特别严重的表现，此前仅被报道过一次。
我们报告了一例罕见的1型拇指纽扣畸形伴IP关节脱位的病例，患者为一名42岁、需求较高且有自身免疫性疾病病史的女性。我们描述了使用MCP关节融合术和临时IP关节穿针固定成功治疗这种严重拇指畸形的过程，该治疗方法保留了拇指的功能和稳定性。在1年的随访中，患者报告拇指功能良好，未出现IP关节脱位的情况。
在先前的文献中，对于严重的拇指纽扣畸形，推荐采用MCP关节成形术联合IP关节融合术，但这可能不适用于年轻、需求较高的患者。外科医生应全面了解每位患者的解剖结构和功能目标，以制定最佳的治疗策略。在该患者群体中，MCP关节融合术和临时IP关节穿针固定的成功体现在随访1年时IP关节活动范围得以维持，且在捏取和抓握活动中未出现脱位。
