Buddy strapping is not inferior to a hand-based orthosis for boxer's fracture in the early weeks of hand therapy: A randomized controlled trial.

BACKGROUND

Conservatively managed fifth metacarpal neck or "boxer's" fractures are referred to hand therapists for rehabilitation, managed with either buddy strapping or immobilization orthoses. These two interventions have similar long-term outcomes; however, we do not know if patients have reduced daily living function, more pain, or are less satisfied with buddy straps in the first 6 weeks of care.

PURPOSE: To determine whether buddy strapping is noninferior to a hand-based orthosis for adults with fifth metacarpal neck fracture requiring nonsurgical management in the first 6 weeks following injury.

STUDY

DESIGN

Parallel group, randomized, controlled, noninferiority trial (Trial ID: ACTRN12618001324202).

METHODS

Participants were randomly allocated to two groups: (1) buddy strapping or (2) hand-based orthosis. Blinded assessors administered assessments of activities of daily living, hand function, pain, and patient satisfaction at enrollment, 1, 3 and 6 weeks. The Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) was the primary outcome. Data were analyzed using linear mixed‑effects models incorporating all time points, consistent with CONSORT non‑inferiority guidance. The non‑inferiority margin was based on the individual‑level minimal clinically important difference, and findings were interpreted in this context.

RESULTS

Sixty-two (n = 62) adults were randomized to orthosis (n = 32, mean age = 28.7 years, male = 29) or buddy strapping (n = 30, mean age = 29.0 years, male = 25). At 6 weeks, mean QuickDASH was not significantly different between groups (orthosis = 10.7, CI = 2.4-19, buddy strapping = 9.6, CI = 1.5-17.6). Linear mixed modeling showed a similar trajectory of improvement over time. No clinically meaningful between‑group differences were observed for secondary outcomes, and no device‑related adverse events were reported.

CONCLUSIONS

Buddy strapping demonstrated comparable outcomes to a hand‑based orthosis over the first 6 weeks of rehabilitation. Within the limitations of sample size (underpowered), buddy strapping appears to be a safe and acceptable management option.