Immediate mobilization gives good results in boxer's fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization.
BACKGROUND
The management of the subcapital fracture of the fifth metacarpal bone, the boxer's fracture, is still a matter of debate. Besides the question of which rate of angulation is acceptable before a reduction becomes necessary, recommendations for further treatment of this fracture vary as well. Therefore, the aim of our study was to compare randomly and prospectively the results of an immobilization treatment for 3 weeks with cast with a functional treatment, all with accepted angulations up to 70 degrees.


METHODS
Between June 1997 and June 1998, 40 patients were randomly allocated either to treatment with an ulnar gutter plaster cast for a period of 3 weeks followed by mobilization, or a pressure bandage for 1 week and immediate mobilization within limits imposed by pain. All patients were monitored at the outpatient clinic 6 and 12 weeks after the fracture. Clinical outcome was measured by the range of motion (ROM) of the fifth metacarpal phalangeal (MCP) joint, and by interviewing the patients about their satisfaction, pain perception, return to work and hobby, and need for physiotherapy.


RESULTS
A total of 35 patients with a mean age of 29 years (range 15-84) completed the required follow-up program. The mean angulation of the fracture was 39 degrees (range 15-70 degrees ). Between the two groups, no statistical differences were scored with respect to ROM, satisfaction, pain perception, return to work and hobby, and need for physiotherapy. According to a sample size calculation (power 90%, alpha 0.05, to detect 5 degrees difference in ROM), 12 patients needed to be included in each group to reach significance.


CONCLUSIONS
A pressure bandage for 1 week, followed by immediate mobilization, is a sufficient alternative treatment for a boxer's fracture, if it is not angulated greater than 70 degrees and not rotated. This treatment resulted in satisfied patients who perceived no more pain and had a good ROM of the fifth MCP joint. Reduction of angulated fractures of less than 70 degrees seems not of value, with respect to ROM of the fifth MCP joint.
Statius Muller
Markwin G
MG
Department of Surgery, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
Poolman
Rudolf W
RW
van Hoogstraten
M Julie
MJ
Steller
E Philip
EP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001914:Boxing / Q000293:injuries*; D002370:Casts, Surgical; D004434:Early Ambulation / Q000379:methods*; D005260:Female; D050723:Fractures, Bone / Q000628:therapy*; D006230:Hand Injuries / Q000628:therapy*; D006801:Humans; D007103:Immobilization; D008297:Male; D008663:Metacarpus / Q000293:injuries*; D008875:Middle Aged