title: Fifth metacarpal neck fractures treated with soft wrap/buddy taping compared to reduction and casting: results of a prospective, multicenter, randomized trial.
abstract: BACKGROUND
  The majority of fifth metacarpal neck fractures (boxers fracture) are treated conservatively without surgery. The purpose of this prospective, randomized, multicenter trial was to determine if the outcomes of soft wrap and buddy taping (SW) was noninferior to reduction and cast (RC) in boxer's fracture with palmar angulation ≤70° and no rotational deformity.
  
  
  METHODS
  Sixty-eight patients with similar characteristics were prospectively enrolled and randomized at four institutions. Our primary outcome was measured by the shortened Disabilities of the Arm, Shoulder and Hand (quickDASH) questionnaire at 4 months. Noninferiority was claimed if there was no more than +10 points difference in the quickDASH. Other secondary radiographic and clinical outcomes were measured.
  
  
  RESULTS
  At 4 months, mean difference in the quickDASH between the two groups was -10.4 (95 % confidence interval, -27.0; +6.2) which was under the pre-specified margin. There was no significant difference between both groups' secondary outcomes of pain, satisfaction with the esthetic appearance, mobility of the metacarpophalangeal-joint at flexion and extension, or power grip. Increased fracture angulation, as measured on follow-up radiographs, was not significantly different between both groups. The degree of palmar fracture angulation was not related to work leave or profession. Duration of time off from work was 11 days shorter in SW compared to RC (P = 0.03).
  
  
  CONCLUSIONS
  This study supports the use of soft wrap and buddy taping for treatment of boxer's fracture with palmar angulation ≤70° and no rotational deformity. Although there was no statistical difference in satisfaction with the esthetic appearance, the patient must be willing to accept the loss of the "knuckle" with this treatment method.
authors.affiliation: University Hospital of Geneva (HUG), Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland. Jan.vanaaken@hcuge.ch.
authors.forename: Jan
authors.identifier: http://orcid.org/0000-0003-0715-9113
authors.initials: J
authors.lastname: van Aaken
authors.affiliation: Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland.
authors.forename: Cesare
authors.initials: C
authors.lastname: Fusetti
authors.affiliation: Ente Ospedaliero Cantonale (EOC), Locarno, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Luchina
authors.affiliation: Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland.
authors.forename: Stefania
authors.initials: S
authors.lastname: Brunetti
authors.affiliation: University Hospital of Geneva (HUG), Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Beaulieu
authors.affiliation: University Hospital of Geneva (HUG), Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
authors.forename: Angèle
authors.initials: A
authors.lastname: Gayet-Ageron
authors.affiliation: Naval Medical Center in San Diego, San Diego, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hanna
authors.affiliation: Mayo Clinic, Rochester, USA.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Shin
authors.affiliation: Naval Medical Center in San Diego, San Diego, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Hofmeister
mesh_terms: D000328:Adult; D002370:Casts, Surgical; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000628:therapy*; D006230:Hand Injuries / Q000628:therapy*; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D050279:Metacarpal Bones / Q000293:injuries*; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: 5th metacarpal neck fracture; Boxer’s fracture; Cast; Prospective; Randomized; Soft dressing; Treatment