Is Buddy Taping as Effective as Plaster Immobilization for Adults With an Uncomplicated Neck of Fifth Metacarpal Fracture? A Randomized Controlled Trial

Abstract

We compare buddy taping with plaster casting for uncomplicated fifth metacarpal (boxer's) fractures. We hypothesize buddy taping will give superior functional outcomes at 12 weeks, defined as a 10-point difference on the Shortened Disabilities of the Arm, Shoulder and Hand (quickDASH) score. Methods: This randomized controlled trial included patients aged 18 to 70 years, with uncomplicated boxer's fractures in 2 hospitals in Queensland, Australia. The intervention consisted of buddy taping of the ring and little fingers on the affected side, in which the control group received plaster casting. Primary outcome was hand function as measured by quickDASH score (0 to 100, with 0 indicating no disability) at 12 weeks. Secondary outcomes measured at 3, 6, and 12 weeks included time off work and activities, pain, satisfaction, and the EuroQol 5-Dimension 3-Level score (measure of overall health). Results: Ninety-seven patients with primary endpoint data were available for analysis, 48 in the buddy taping group and 49 in the plaster group. At 12 weeks, median quickDASH scores were the same for both groups (buddy 0, interquartile range [IQR] 0 to 2.3; plaster 0, IQR 0 to 4; difference 0; 95% confidence interval of the difference 0 to 0). Patients in the buddy taping group missed a median 0 days (IQR 0 to 7) of work compared with the plaster group's 2 days (IQR 0 to 14). Other secondary outcome measures were the same in both groups. Conclusion: We found that patients with boxer's fractures who were randomized to buddy taping had functional outcomes similar to those of patients randomized to plaster cast at 12 weeks. We advocate a minimal intervention such as buddy taping for uncomplicated boxer's fractures. [

Management of Fifth Metacarpal Neck Fracture (Boxer's Fracture): A Literature Review

“…An uncomplicated -closed, not angulated, and not malrotated or otherwise displaced -fifth metacarpal fracture can be managed with initial immobilisation with an ulnar gutter splint [7]. Alternatively, a more minimalistic approach of strapping the little and ring finger together, also known as buddy taping, can be used in uncomplicated cases [12]. Conventional teachings suggest that the position of the hand for fracture splinting should be: the wrist extended at 20 degrees, 60-70 degree of flexion at the metacarpophalangeal (MCP), and interphalangeal joints in extension [13].…”

Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically

“…Nine studies report on time off work. Five found sick-leave shorter after early mobilization in a functional brace or by buddy taping than after splinting (Bansal and Craigen, 2007; Harding et al., 2001; Pellatt et al., 2019; van Aaken et al., 2016) or intramedullary antegrade pinning (Sletten et al., 2015). Statius Muller et al.…”

Splints and immobilisation approaches used for second to fifth metacarpal fractures: a systematic review

“…19 Recent literature supports buddy strapping instead of POP immobilisation for uncomplicated neck of fifth metacarpal fractures, and for neck of fifth metacarpal fractures without rotation deformities and for volar angulation less than 70°, due to less time off work and no complications due to POP immobilisation. 24,25 At eight weeks, participants who sustained neck of fifth metacarpal fractures managed with an elastic bandage around their metacarpals and wrist with early protected movement, displayed stronger grip strengths than the immobilisation in a U-shaped splint participants. 26 Patients with closed, isolated neck of fifth metacarpal fractures without rotational deformity were managed either by functional metacarpal splints supporting only the metacarpals or an ulnar gutter splint immobilising the wrist.…”