The majority of fifth metacarpal neck fractures (boxers fracture) are treated conservatively without surgery. The purpose of this prospective, randomized, multicenter trial was to determine if the outcomes of soft wrap and buddy taping (SW) was noninferior to reduction and cast (RC) in boxer’s fracture with palmar angulation ≤70° and no rotational deformity.
Materials and methods
Sixty-eight patients with similar characteristics were prospectively enrolled and randomized at four institutions. Our primary outcome was measured by the shortened Disabilities of the Arm, Shoulder and Hand (quickDASH) questionnaire at 4 months. Noninferiority was claimed if there was no more than +10 points difference in the quickDASH. Other secondary radiographic and clinical outcomes were measured.
At 4 months, mean difference in the quickDASH between the two groups was −10.4 (95 % confidence interval, −27.0; +6.2) which was under the pre-specified margin. There was no significant difference between both groups’ secondary outcomes of pain, satisfaction with the esthetic appearance, mobility of the metacarpophalangeal-joint at flexion and extension, or power grip. Increased fracture angulation, as measured on follow-up radiographs, was not significantly different between both groups. The degree of palmar fracture angulation was not related to work leave or profession. Duration of time off from work was 11 days shorter in SW compared to RC (P = 0.03).
This study supports the use of soft wrap and buddy taping for treatment of boxer’s fracture with palmar angulation ≤70° and no rotational deformity. Although there was no statistical difference in satisfaction with the esthetic appearance, the patient must be willing to accept the loss of the “knuckle” with this treatment method.
This is a preview of subscription content,to check access.
Access this article
Hunter JM, Cowen NJ (1970) Fifth metacarpal fractures in a compensation clinic population. A report on one hundred and thirty-three cases. J Bone Joint Surg Am 52(6):1159–1165
Poolman RW, Goslings JC, Lee JB, Statius Muller M, Steller EP, Struijs PA (2005) Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database Syst Rev (3):CD003210. doi:10.1002/14651858.CD003210.pub3
Beredjiklian PK (2009) Small finger metacarpal neck fractures. J Hand Surg Am 34(8):1524–1526. doi:10.1016/j.jhsa.2009.06.015
Braakman M, Oderwald EE, Haentjens MH (1998) Functional taping of fractures of the 5th metacarpal results in a quicker recovery. Injury 29(1):5–9
van Aaken J, Kampfen S, Berli M, Fritschy D, Della Santa D, Fusetti C (2007) Outcome of boxer’s fractures treated by a soft wrap and buddy taping: a prospective study. Hand (N Y) 2(4):212–217. doi:10.1007/s11552-007-9054-2
Hansen PB, Hansen TB (1998) The treatment of fractures of the ring and little metacarpal necks. A prospective randomized study of three different types of treatment. J Hand Surg Br 23(2):245–247
Statius Muller MG, Poolman RW, van Hoogstraten MJ, Steller EP (2003) Immediate mobilization gives good results in boxer’s fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Arch Orthop Trauma Surg 123(10):534–537. doi:10.1007/s00402-003-0580-2
Hofmeister EP, Kim J, Shin AY (2008) Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study. J Hand Surg Am 33(8):1362–1368. doi:10.1308/003588410X12628812458176
Jones R, Burdett S, Jefferies M, Guha AR (2010) Treating the boxer’s fracture in Wales: a postal survey. Ann R Coll Surg Engl 92(3):236–239. doi:10.1308/003588410X12628812458176 (quiz 239)
Smith KR (2010) Comment on: boxer’s fracture. Ann R Coll Surg Engl 92(5):449. doi:10.1308/003588410X12699663904033
Breddam M, Hansen TB (1995) Subcapital fractures of the fourth and fifth metacarpals treated without splinting and reposition. Scand J Plast Reconstr Surg Hand Surg 29(3):269–270
Bansal R, Craigen MA (2007) Fifth metacarpal neck fractures: is follow-up required? J Hand Surg Eur 32(1):69–73. doi:10.1016/j.jhsb.2006.09.021
Gamble D, Jenkins PJ, Edge MJ, Gilmour A, Anthony IC, Nugent M, Rymaszewski LA (2015) Satisfaction and functional outcome with “self-care” for the management of fifth metacarpal fractures. Hand. doi:10.1007/s11552-015-9749-8
Totty W, Gilula L (1992) Imaging the hand and wrist. In: The traumatized hand and wrist. WB Saunders, Philadelphia, pp 1–19
King JC, Nettrour JF, Beckenbaugh RD (1999) Traction reduction and cast immobilization for the treatment of boxer’s fractures. Tech Hand Up Extrem Surg 3(3):174–180
Jahss S (1938) Fractures of the metacarpals: a new method of reduction and immobilization. J Bone Joint Surg 20:178–186
Gummesson C, Ward MM, Atroshi I (2006) The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord 7:44. doi:10.1186/1471-2474-7-44
Haefeli M, Elfering A (2006) Pain assessment. Eur Spine J 15(Suppl 1):S17–S24. doi:10.1007/s00586-005-1044-x
Braakman M (1996) Normal radiographic angulation in the 4th and 5th metacarpal: a reference guide. Eur J Radiol 22(1):38–41
Roy JS, MacDermid JC, Woodhouse LJ (2009) Measuring shoulder function: a systematic review of four questionnaires. Arthritis Rheum 61(5):623–632. doi:10.1002/art.24396
Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C (2001) Measuring the whole or the parts? Validity, reliability, and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity. J Hand Ther 14(2):128–146
Ford DJ, Ali MS, Steel WM (1989) Fractures of the fifth metacarpal neck: is reduction or immobilisation necessary? J Hand Surg Br 14(2):165–167
Holst-nielsen F (1976) Subcapital fractures of the four ulnar metacarpal bones. Hand 8(3):290–293
Ali A, Hamman J, Mass DP (1999) The biomechanical effects of angulated boxer’s fractures. J Hand Surg Am 24(4):835–844
Birndorf MS, Daley R, Greenwald DP (1997) Metacarpal fracture angulation decreases flexor mechanical efficiency in human hands. Plast Reconstr Surg 99(4):1079–1083 (discussion 1084–5)
Faraj AA, Davis TR (1999) Percutaneous intramedullary fixation of metacarpal shaft fractures. J Hand Surg Br 24(1):76–79
Lamraski G, Monsaert A, De Maeseneer M, Haentjens P (2006) Reliability and validity of plain radiographs to assess angulation of small finger metacarpal neck fractures: human cadaveric study. J Orthopaed Res 24(1):37–45. doi:10.1002/jor.20025
Sletten IN, Nordsletten L, Hjorthaug GA, Hellund JC, Holme I, Kvernmo HD (2013) Assessment of volar angulation and shortening in 5th metacarpal neck fractures: an inter- and intra-observer validity and reliability study. J Hand Surg Eur 38(6):658–666. doi:10.1177/1753193412461582
Abdon P, Muhlow A, Stigsson L, Thorngren KG, Werner CO, Westman L (1984) Subcapital fractures of the fifth metacarpal bone. Arch Orthop Trauma Surg 103(4):231–234
Arafa M, Haines J, Noble J, Carden D (1986) Immediate mobilization of fractures of the neck of the fifth metacarpal. Injury 17(4):277–278
Kuokkanen HO, Mulari-Keranen SK, Niskanen RO, Haapala JK, Korkala OL (1999) Treatment of subcapital fractures of the fifth metacarpal bone: a prospective randomised comparison between functional treatment and reposition and splinting. Scand J Plast Reconstr Surg Hand Surg 33(3):315–317
Pace GI, Gendelberg D, Taylor KF (2015) The effect of closed reduction of small finger metacarpal neck fractures on the ultimate angular deformity. J Hand Surg Am 40(8):1582–1585. doi:10.1016/j.jhsa.2015.05.013
All authors disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) this work. The study was approved by the ethical committee/Institutional Review Board of the four participating centers and all patients underwent an informed consent prior to entering the trial.
Conflict of interest
All authors disclose any financial and personal relationship with other people or organizations that could inappropriately influence (bias) this work.
About this article
Cite this article
van Aaken, J., Fusetti, C., Luchina, S. et al. Fifth metacarpal neck fractures treated with soft wrap/buddy taping compared to reduction and casting: results of a prospective, multicenter, randomized trial. Arch Orthop Trauma Surg 136, 135–142 (2016). https://doi.org/10.1007/s00402-015-2361-0