From the Guidelines
A boxer's fracture is typically treated with an ulnar gutter splint, which immobilizes the wrist and metacarpophalangeal joints to promote proper healing and prevent complications. The most recent and highest quality study, 1, published in 2024, supports the use of splinting as a first aid measure to reduce pain, prevent further injury, and facilitate transport. Although there is a lack of evidence demonstrating clear benefits from fracture splinting in the prehospital first aid setting, fracture immobilization is an essential part of definitive fracture treatment.
Key Considerations for Splinting
- The splint should extend from the mid-forearm to the fingertips, covering the ring and little fingers while leaving the thumb, index, and middle fingers free for function.
- The splint should be worn for approximately 3-4 weeks, depending on the severity of the fracture and healing progress.
- During this time, it's essential to elevate the hand above heart level when possible to reduce swelling and to perform gentle range of motion exercises for the uninvolved fingers to prevent stiffness.
- The splint positioning is crucial because it maintains the metacarpal bones in a functional position and prevents rotation of the fracture fragments, as noted in 1.
Importance of Proper Splinting
- Proper splinting helps prevent shortening of the collateral ligaments of the metacarpophalangeal joints, which could lead to stiffness and decreased hand function if the fingers were splinted in extension.
- After the initial immobilization period, gradual rehabilitation with hand therapy exercises should be initiated to restore strength and range of motion, as suggested by 1.
- It's also important to note that blue, purple, or pale extremities may indicate poor perfusion to the extremity, a limb-threatening injury for which professional medical care should be sought immediately, as stated in 1.
From the Research
Recommended Splint for Boxer's Fracture
The recommended splint for a boxer's fracture (metacarpal fracture) varies depending on the severity and type of fracture.
- For fractures with significant volar angulation, a combination of malleable aluminium alloy splint and plaster of Paris cast may be used, as shown in a study from 2.
- However, other studies suggest that cast immobilization may not be necessary for most cases, and a soft wrap without reduction may be sufficient 3.
- Buddy strapping with a Futura splint can provide good functional results for fractures with angulation up to 70 degrees 4.
- Immediate mobilization with a pressure bandage for 1 week can also be an effective treatment for fractures with angulation up to 70 degrees, as shown in a prospective randomized trial 5.
Treatment Options
Treatment options for boxer's fractures depend on the type and severity of the fracture, including:
- Closed, non-displaced fractures without angulation or rotation: non-operative management may be suitable 4, 6
- Open fractures, fractures with angulation and/or mal-rotation, and fractures with neuro-vascular injury: operative management may be necessary 4, 6
- Fractures with significant comminution or multiple metacarpal fractures: plate and screw fixation may be preferred 4