Boxer's fracture: Difference between revisions
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{{Hand and finger fractures DDX}} | {{Hand and finger fractures DDX}} | ||
== | ==Evaluation== | ||
[[File:Neck Fracture of the Fourth Metacarpal Bone.png|thumb|Boxer's Fracture]] | [[File:Neck Fracture of the Fourth Metacarpal Bone.png|thumb|Boxer's Fracture (4th metacarpal)]] | ||
*AP and lateral hand | [[File:Fractured5thMetacarpalHead2018.jpg|thumb|Boxer's Fracture (5th metacarpal)]] | ||
===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== | ==Management== | ||
{{General Fracture Management}} | |||
===Acute Reduction=== | |||
* | ''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 | |||
*[https://www.youtube.com/watch?v=40irKoUJqsM Video] on how to perform reduction | |||
{{Metacarpal fracture goals}} | |||
===Immobilization=== | |||
''See Diagnosis section for definition'' | |||
*Uncomplicated | |||
**Buddy taping<ref>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 </ref> | |||
***Similar functional outcomes those randomized to plaster cast with earlier return to work <ref>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 </ref> | |||
***Similar satisfaction and pain control as those randomized to plaster casting <ref>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 </ref> | |||
***Shorter ER Stay <ref>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 </ref> | |||
*Complicated: | |||
**[[Forearm volar splint]] with extension over the head of the MCP joint provides equal effect and is better tolerated<ref>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.</ref> | **[[Forearm volar splint]] with extension over the head of the MCP joint provides equal effect and is better tolerated<ref>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.</ref> | ||
***Classically, the [[Ulnar Gutter Splint]] was recommended | |||
==Disposition== | |||
*Outpatient management for closed fractures that are distally neurovascularly intact | |||
===Indications for Subsequent Out-Patient Orthopedic Surgery=== | |||
*Intra-articular fracture | |||
*Rotational malalignment of digit | |||
*Significantly displaced or angulated fractures (see above criteria) | |||
*Multiple metacarpal shaft fractures | |||
*Loss of stability from border digit during healing process | |||
==See Also== | ==See Also== | ||
*[[Non-thumb metacarpal fractures]] | *[[Non-thumb metacarpal fractures]] | ||
*[[Hand and finger fractures]] | |||
==References== | ==References== | ||
[[Category: | <references/> | ||
[[Category:Orthopedics]] | |||
Latest revision as of 16:29, 1 June 2022
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
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Acute Reduction
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
- Video on how to perform reduction
Metacarpal Fracture (Post-Reduction) Goals
| Finger | Shaft Angulation (degrees) | Shaft Shortening (mm) | Neck Angulation (degrees) | Rotational Deformity |
| Index & Long Finger | 10-20 | 2-5 | 10-15 | None |
| Ring Finger | 30 | 2-5 | 30-40 | None |
| Little Finger | 40 | 2-5 | 50-60 | None |
Immobilization
See Diagnosis section for definition
- Uncomplicated
- Complicated:
- Forearm volar splint with extension over the head of the MCP joint provides equal effect and is better tolerated[5]
- Classically, the Ulnar Gutter Splint was recommended
- Forearm volar splint with extension over the head of the MCP joint provides equal effect and is better tolerated[5]
Disposition
- Outpatient management for closed fractures that are distally neurovascularly intact
Indications for Subsequent Out-Patient Orthopedic Surgery
- Intra-articular fracture
- Rotational malalignment of digit
- Significantly displaced or angulated fractures (see above criteria)
- Multiple metacarpal shaft fractures
- Loss of stability from border digit during healing process
See Also
References
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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.