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

Jan van Aaken, Cesare Fusetti, Stefano Luchina, Stefania Brunetti, Jean Yves Beaulieu, Angèle Gayet-Ageron, Kathryn Hanna, Alexander Y. Shin, Eric Hofmeister

Research output: Contribution to journalArticle

16 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)135-142
Number of pages8
JournalArchives of Orthopaedic and Trauma Surgery
Volume136
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • 5th metacarpal neck fracture
  • Boxer’s fracture
  • Cast
  • Prospective
  • Randomized
  • Soft dressing
  • Treatment

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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