Boxer's fracture: Difference between revisions
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===Diagnosis=== | ===Diagnosis=== | ||
*Typically on plain hand x-ray showing fracture of the 4th or 5th metacarpal | *Typically on plain hand x-ray showing fracture of the 4th or 5th metacarpal | ||
*"Uncomplicated" defined as: | |||
**Minimally displaced | |||
**Closed | |||
**Isolated injury | |||
**Fracture angulation of <70 degrees | |||
==Management== | ==Management== | ||
Revision as of 01:26, 18 September 2019
Background
- Fracture of the 4th or 5th metacarpal caused by an axial load, typically from punching a person or object
Clinical Features
- Pain or swelling along the 4th or 5th metacarpals
- Volar angulation of metacarpal or "missing 4th/5th knuckle"
- Look for areas of skin breakdown which may signify a fight bite that can result in a closed fist infection if untreated
Differential Diagnosis
Hand and Finger Fracture Types
Evaluation
Workup
- AP and lateral hand x-ray
Diagnosis
- Typically on plain hand x-ray showing fracture of the 4th or 5th metacarpal
- "Uncomplicated" defined as:
- Minimally displaced
- Closed
- Isolated injury
- Fracture angulation of <70 degrees
Management
- Indications for reduction are contingent upon angulation and rotation
- Any rotational deformity should be reduced to allow proper hand function (seen as scissoring)
- Angulation >30° in the 4th digit or >40° in the 5th digit should be reduced
- Splinting
- Classically the Ulnar Gutter Splint has been recommended
- Forearm volar splint with extension over the head of the MCP joint provides equal effect and is better tolerated[1]
- Buddy taping[2]
- 2019 Annals of EM suggested no statistical difference in certain outcomes between plaster and buddy tape.
- Per paper, applicable when pt 18-70 years old without open, intraarticular, or comminuted fracture, and angulation < 70 degrees.
Disposition
- Outpatient management
See Also
References
- ↑ Hofmeister EP, Kim J, and Shin AY. Comparison of 2 Methods of Immobilization of Fifth Metacarpal Neck Fractures: A Prospective Randomized Study. The Journal of Hand Surgery. 2008; 33(8):1362–1368.
- ↑ Pellatt, R., Fomin, I., Pienaar, C., Bindra, R., Thomas, M., Tan, E., … Keijzers, G. (2019). Is Buddy Taping as Effective as Plaster Immobilization for Adults With an Uncomplicated Neck of Fifth Metacarpal Fracture? A Randomized Controlled Trial. Annals of Emergency Medicine, 74(1), 88–97. doi: 10.1016/j.annemergmed.2019.01.032