None listed
Conditions
Brief summary
Metacarpal neck fractures represent the most common hand injury, with 5th metacarpal fractures accounting for the majority . Known as Boxer’s Fractures, these injuries are commonly the result of a closed fist strike, and are seen more frequently in young males, often associated with an aggressive strike, or a fall onto a fist during sporting activities. Traditionally, 5th metacarpal neck fractures have been managed with closed reduction and cast immobilisation and followed up in an orthopaedic clinic. However, due to the nature of the injury and then anatomy of the hand musculature, closed reduction often has little benefit in reducing the fracture and improving angulation. Moreover, it has been shown that there is no functional deficit in healed fractures with up to 70 degrees of angulation, provided there is no rotational deformity of the fracture fragments . Several orthopaedic and emergency departments now manage minimally-rotated Boxer’s Fractures with buddy strapping alone, thus encouraging mobilisation and an immediate return to work and activities. Currently, there is no consensus as to the best management of 5th metacarpal neck fractures. A previous Cochrane review found insufficient evidence to recommend a particular management course, but reported no adverse outcomes from simple buddy strapping. More recently, a study comparing closed reduction and plaster, with buddy strapping and soft wrap, suggested no adverse outcome to strapping, and a significant improvement on time to return to work for the buddy strapping group. The patient demographic associated with Boxer’s Fractures (young, male, working) historically have a suboptimal compliance with follow up. In one study, 10% of patients removed splints themselves and never returned to follow up. If these injuries can be managed with minimal intervention and community follow up, time would be saved in both the emergency department and orthopaedic outpatients, with a concurrent economic benefit. We propose a prospective, randomised study to assess outcomes of 5th metacarpal neck fractures (Boxer’s Fracture). The proposed study will compare minimal intervention (buddy strapping of ring and little fingers) with current practice; plaster cast in position of safe immobilisation (POSI). This study aims to provide an answer to the question regarding the best management of these fractures.
Interventions
Comparison of traditional plaster casts vs simple buddy taping for 5th metacarpal neck fractures
1. Routine Care Group (Plaster Group): ulnar gutter slab plaster cast in position of safe immobilisation (POSI). This will either be done by the on call plaster technician, or by a doctor, physiotherapist or nurse practitioner. The cast will be changed to a fibreglass cast at 1 week (first fracture clinic) and removed at 3 weeks (second fracture clinic). The patient will be seen again at 6 weeks
Comparison of traditional plaster casts vs simple buddy taping for 5th metacarpal neck fractures 1. Routine Care Group (Plaster Group): ulnar gutter slab plaster cast in position of safe immobilisation (POSI). This will either be done by the on call plaster technician, or by a doctor, physiotherapist or nurse practitioner. The cast will be changed to a fibreglass cast at 1 week (first fracture clinic) and removed at 3 weeks (second fracture clinic). The patient will be seen again at 6 weeks (third fracture clinic) for repeat X-rays. They will be followed up by phone at 12 weeks. 2. Minimal Intervention Group (Buddy Group): buddy strap between little and ring fingers. This will either be done by the on call plaster technician, or by a doctor, physiotherapist or nurse practitioner. This group will be followed up at 1 and 3 weeks (just review clinics with no further intervention) and at 6 weeks for repeat x-rays. Strapping removed at 3 weeks. They will be followed up at 12 weeks by phone. For both groups, one of the important functions of the fracture clinic follow up is to allow regular patient review. Also, the patients are being followed up in specific clinics with hand surgeons (Dr Mike Thomas and Prof Randy Bindra) who were involved in the study design.
Sponsors
Gold Coast University Hospital
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
A 5th metacarpal neck or Boxer’s fracture is defined as: Fracture of the neck of 5th metacarpal Confirmed radiologically in at least 2 planes of view
Exclusion criteria
Patients less than 18 and over 70 years of age Open fracture Rotational deformity Intra-articular fracture Communted fracture Associated tendon injury Polytrauma – other significant injuries sustained at the time of injury Unable/Unwilling to consent to study – i.e. intoxicated, dementia Fracture angulation greater than 70 degrees at initial radiology
Outcome results
None listed