Boxer's fracture
Revision as of 01:36, 18 September 2019 by Rossdonaldson1 (talk | contribs) (→Splinting and Imobilization)
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
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
Immobilization
- Uncomplicated: Buddy taping[1]
- Similar functional outcomes those randomized to plaster cast with earlier return to work[2]
- 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[3]
Disposition
- Outpatient management
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
- ↑ 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.