Effectiveness of reduction in conservative treatment of boxer fractures : A retrospective study of 115 patients.

PURPOSE: Subcapital fractures of the fifth metacarpal bone are one of the most common fractures of the hand. Surgical and conservative treatment is possible but the respective indications remain controversial. Closed reduction and cast retention are commonly performed for these fractures but their effectiveness in fracture retention is unclear. Therefore, the aim of this study was to evaluate the efficacy of closed reduction with consecutive below-elbow casting and finger splinting.

METHODS

Radiographs of 115 patients with a subcapital fracture of the fifth metacarpal bone at an academic level 1 trauma center were retrospectively reviewed and volar angulation was assessed at initial presentation, after reduction and at the end of treatment.

RESULTS

The patients mean age was 32 years (IQR 25-37 years) and 93% were male (n = 107). Cast immobilization was 4 weeks in all cases. Volar angulation at initial presentation was 49.9° ± 11°. After reduction an angle of 40.9° ± 9.2°was observed. After cast removal, an angulation of 42.4° ± 9.9° was observed. A repeated measures ANOVA with a Huynh-Feldt correction showed that the difference in mean fracture angulation was statistically significant.

CONCLUSION

This study indicates that improved fracture angulation can be maintained with closed reduction and retention in a below-elbow cast with finger splinting. Further studies have to be conducted to investigate whether improved fracture angulation results in more favorable clinical outcomes.