What is the diagnosis for a patient with a healed fracture of the fifth metacarpal (metacarpal bone) diaphysis, showing mild post-traumatic deformity and volar curvature, but preserved joint spacing and no foreign body in the soft tissues?

From the Guidelines

The patient has a healed fracture of the fifth metacarpal bone with mild deformity, and no further intervention is required unless there is pain or functional limitation. The fracture has healed with a slight forward (volar) curvature, which is a common outcome for this type of injury, as noted in the American College of Radiology guidelines for acute hand and wrist trauma 1. Despite this deformity, all the joints in the hand maintain proper spacing, suggesting normal function. No foreign objects were detected in the soft tissues. This type of injury is commonly known as a "boxer's fracture" and typically results from punching a hard surface with a closed fist. Some key points to consider in the management of this condition include:

• The use of radiography as the initial imaging modality for suspected acute hand and wrist trauma, as recommended by the American College of Radiology 1
• The importance of evaluating for concomitant ligamentous injuries, which may affect surgical treatment, although this is not typically a concern in cases with fully healed fractures 1
• The potential benefits of physical therapy in improving hand function and reducing pain, if necessary 1 The patient should be reassured that the slight deformity is cosmetic and unlikely to affect hand function in daily activities. In terms of further evaluation, some studies suggest that MRI or CT may be useful in certain cases, such as when there is high clinical suspicion for fracture but initial radiographs are negative or equivocal 1. However, in this case, the fracture has already healed, and further imaging is not necessary unless there are concerns about ongoing pain or functional limitation.

From the Research

Findings and Impression

• The patient has an old healed fracture of the fifth metacarpal diaphysis with mild posttraumatic deformity and some volar curvature.
• Joint spacing throughout the hand looks well preserved, and no opaque foreign body is seen within the soft tissues.
• The impression is a healed fifth metacarpal fracture with resultant modest deformity.

Relevant Studies

• A study published in 2019 2 compared acetaminophen, ibuprofen, and oxycodone for pain management after hand surgery, finding no clinically significant difference in pain experience or capsule consumption between postoperative opioid and nonopioid medication.
• Another study from 2015 3 found that ibuprofen was consistently superior to paracetamol at conventional doses in a range of painful conditions, including acute post-operative pain and osteoarthritis.
• A 2018 study 4 compared intravenous ibuprofen and acetaminophen for postoperative multimodal pain management in bariatric surgery, finding that intravenous ibuprofen reduced the severity of pain but did not significantly reduce opioid consumption.
• A 2013 study 5 found that the combination of ibuprofen and acetaminophen did not reduce pain scores or the need for rescue analgesics compared to either agent alone in patients with acute musculoskeletal pain.
• A 2016 white paper 6 provided guidelines for the prescription of orthotic services, device delivery, education, and follow-up care, but did not directly address the patient's condition.

Treatment Options

• Based on the studies, ibuprofen may be a suitable option for managing pain related to the healed fracture, although the patient's specific condition and medical history should be taken into account.
• The use of orthotic devices may also be considered to support the patient's hand and reduce discomfort, as outlined in the 2016 guidelines 6.