The Boxer's Fracture: Splint Immobilization Is Not Necessary

Dunn, John C.; Kusnezov, Nicholas; Orr, Justin D.; Pallis, Mark; Mitchell, Justin

doi:10.3928/01477447-20160315-05

Cited by 29 publications

(37 citation statements)

References 25 publications

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“…Previous studies and literature were used to build this project of updating our practice to match current evidence-based practice and save healthcare costs. 9,10,13–16…”

Section: Methodsmentioning

confidence: 99%

“…5,6 The concern is that residual angulation at the fifth metacarpal may leave patients with discomfort and aesthetic complaints. 7,8 A recent review by Dunn et al 9 debunked this theory; the authors contend that given acceptable short- and long-term outcomes, it is reasonable to pursue nonoperative treatment for up to 70 degrees 10 apex dorsal angulation without a rotational deformity. These authors also demonstrated that the evidence suggests a soft wrap with buddy taping the fourth and fifth digit without reduction yields equivalent results to closed reduction and splint treatment.…”

Section: Introductionmentioning

confidence: 99%

“…These authors also demonstrated that the evidence suggests a soft wrap with buddy taping the fourth and fifth digit without reduction yields equivalent results to closed reduction and splint treatment. 9…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reducing Healthcare Costs in the Management of Pediatric Metacarpal Neck Fractures

Beals

Lin

Holstine

et al. 2019

Pediatric Quality &Amp; Safety

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Background:We hypothesize that a quality improvement initiative utilizing a Velcro ulnar gutter brace over traditional casting will impart significant savings without compromising clinical outcomes in the management of small metacarpal neck fractures.Methods:Baseline data on number and treatment regimens of small metacarpal neck fractures were collected starting in October 2015. Velcro ulnar gutter braces were purchased for all orthopedic clinics in December 2016. Patients with <70 degrees of angulation and no rotational deformity of the small finger were eligible to have brace treatment without reduction of the fracture. Data were collected each month on several patients managed by Velcro ulnar gutter brace.Results:Three hundred twelve pediatric patients met nonoperative guidelines. Before the intervention, patients were casted and followed radiographically for a minimum of 2 orthopedic clinic visits—which total $916.25 in charges. From October 2015 to November 2016, we treated <1% (1/147) of patients with metacarpal neck fractures without casting. Following the implementation of interventions from December 2016 to January 2019, the percentage of patients treated without cast immobilization increased to 54.5% (90/165), with a process mean shift to >65%. These patients did not have a scheduled follow-up or further radiographic evaluation. In the first 26 months of implementation, this decreased healthcare expenditures by $261,846.Conclusions:A quality improvement initiative emphasizing Velcro ulnar gutter brace treatment for pediatric metacarpal neck fractures resulted in a shift away from cast immobilization in >65% of patients, reducing risks and expenses of cast immobilization.

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“…Previous studies and literature were used to build this project of updating our practice to match current evidence-based practice and save healthcare costs. 9,10,13–16…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reducing Healthcare Costs in the Management of Pediatric Metacarpal Neck Fractures

Beals

Lin

Holstine

et al. 2019

Pediatric Quality &Amp; Safety

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“…However, clinical evidence from young active duty military personnel suggests that casting in extension with appropriate 3-point molding provides equivalent functional and radiographic outcomes, with faster application and better tolerability [10,11]. Although a recent review suggests that a simple soft wrap may be sufficient treatment for the ubiquitous metacarpal neck fracture, [12] the included literature does not specifically address athletes.…”

Section: Nonoperative Treatmentmentioning

confidence: 99%

Metacarpal fractures in the athlete

Soong

Chase

Kasparyan

2017

Curr Rev Musculoskelet Med

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Purpose of review To describe current evaluation and treatment of metacarpal fractures in athletes Recent findings Biomechanical and clinical studies involving lower-profile, locking, shorter length, and double-row or separate-dual plate configurations, as well as intramedullary screw fixation, have demonstrated the potential benefits of internal fixation with promising results. Summary Treatment should be customized to the specific athlete and injury, and is often successful without surgery, or with percutaneous pin fixation. Internal fixation of metacarpal fractures has improved with new hardware and new techniques, and may expedite return to play, although further clinical studies are needed.

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“…2 In more recent randomized controlled trials and meta-analyses, functional outcomes were similar. 9,10,14 Because discomfort, hand function, and ability to work may be considered variably per patient-clinician interaction, the current data are insufficient to provide consensus for the optimal management of patients with boxer's fractures. 2,9 Editor's Capsule Summary What is already known on this topic Plaster immobilization is a standard emergency department (ED) treatment for patients with a fifth metacarpal (boxer's) fracture, but buddy taping is less studied.…”

Section: Introduction Backgroundmentioning

confidence: 99%

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

Pellatt

Fomin

Pienaar

et al. 2019

Annals of Emergency Medicine

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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. [

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The Boxer's Fracture: Splint Immobilization Is Not Necessary

Cited by 29 publications

References 25 publications

Reducing Healthcare Costs in the Management of Pediatric Metacarpal Neck Fractures

Reducing Healthcare Costs in the Management of Pediatric Metacarpal Neck Fractures

Metacarpal fractures in the athlete

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

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