Boxer's fractures--conservative or operative management?

Sixty-three consecutive patients presented during an 18-month period with isolated closed fractures of the fifth metacarpal neck. Follow-up ranged from 3 to 20 months. Forty were recalled for study and divided into a conservative group (25 patients) and an operative group (15 patients). Both groups were statistically comparable. All patients obtained good results. Subjectively, no patient had long-term pain or dissatisfaction with the functional or cosmetic result. Objectively, all patients regained full joint motion and normal grip strength. Mild rotatory malalignment was present in both groups, but the conservative group had less extensor lag. The main difference between the two groups centered on residual dorsal angulation. This cosmetic deformity was considerably less in the operative group, although the cost of this improvement was significantly longer rehabilitation. Failure to correct dorsal angulation was not associated with functional disability.