From the Guidelines
For a 5th metacarpal boxer's fracture, an ulnar gutter splint is the recommended immobilization method. This recommendation is based on the principle of immobilizing the fracture while allowing for some hand function, which is crucial for preventing stiffness and promoting proper healing [ 1 ]. The ulnar gutter splint extends from the distal forearm to the fingertips, immobilizing the wrist in slight extension (about 20-30 degrees), the metacarpophalangeal (MCP) joints at 70-90 degrees of flexion, and the interphalangeal joints in slight flexion.
- Key characteristics of the splint include:
- Immobilization of the 4th and 5th digits
- Leaving the thumb, index, and middle fingers free for functional use
- Worn for approximately 3-4 weeks for stable, non-displaced fractures
- Additional management strategies include:
- Elevation of the hand above heart level
- Regular ice application for the first 48-72 hours to reduce swelling
- Follow-up radiographs to confirm proper healing, as the diagnosis and treatment are based on a history of trauma, focal pain on palpation, and radiographic studies [ 1 ]. The ulnar gutter splint is preferred over a full cast for most boxer's fractures because it provides adequate immobilization while allowing some hand function and is easier to manage for outpatient care.
From the Research
Splint Options for 5th Metacarpal Boxer's Fracture
- For non-operative management of closed, non-displaced fractures without angulation or rotation, buddy strapping with a Futura splint can provide good functional results 2.
- The ulnar gutter splint is a simple and proven method for immobilizing boxer's fractures, particularly for isolated fractures of the distal fourth or fifth metacarpal bones 3.
- Another option is a plaster splint, which can be used to achieve and maintain reduction of the fracture, and allows for adequate roentgenograms to be taken without redundant plaster over the fracture site 4.
Key Considerations
- The choice of splint depends on the type and severity of the fracture, as well as the presence of any complications such as mal-rotation or neuro-vascular injury 2.
- The acceptable angulation for conservative management is generally considered to be 70 degrees, and fractures with greater angulation may require operative management 2.