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Fifth metacarpal neck fractures treated with soft wrap/buddy taping compared to reduction and casting: results of a prospective, multicenter, randomized trial

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An Erratum to this article was published on 07 September 2016

Abstract

Introduction

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.

Results

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).

Conclusion

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.

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Authors and Affiliations

  1. University Hospital of Geneva (HUG), Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland

    Jan van Aaken, Jean-Yves Beaulieu & Angèle Gayet-Ageron

  2. Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland

    Cesare Fusetti & Stefania Brunetti

  3. Ente Ospedaliero Cantonale (EOC), Locarno, Switzerland

    Stefano Luchina

  4. Naval Medical Center in San Diego, San Diego, USA

    Kathryn Hanna & Eric Hofmeister

  5. Mayo Clinic, Rochester, USA

    Alexander Y. Shin

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  1. Jan van Aaken
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  2. Cesare Fusetti
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  3. Stefano Luchina
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  4. Stefania Brunetti
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Correspondence to Jan van Aaken.

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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.

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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

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