From the Guidelines
For a boxer's fracture, the optimal splint position is in the position found, unless straightening the fracture is necessary to facilitate safe and prompt transport to a medical facility. This approach is based on the most recent guidelines from the American Heart Association and American Red Cross, as outlined in the 2024 guidelines for first aid 1. The key consideration is to reduce pain, minimize the risk of further injury, and facilitate transport to a medical facility.
Key Considerations for Splinting
- The primary goal of splinting is to immobilize the fractured extremity and reduce discomfort, as noted in the guidelines with a Class of Recommendation (COR) of 2a and a Level of Evidence (LOE) of C-EO 1.
- The position of the splint should prioritize stability and comfort, with the understanding that definitive management will be provided in a medical facility.
- It is crucial to cover any open wounds associated with the fracture with a clean dressing to lower the risk of further contamination and infection, as suggested by the guidelines with a COR of 2b and an LOE of C-EO 1.
Clinical Application
In clinical practice, the approach to splinting a boxer's fracture should be pragmatic, focusing on minimizing harm and facilitating prompt medical evaluation. While the ideal splint position might vary based on specific fracture characteristics and patient factors, the guidelines provide a straightforward approach that balances the need for immobilization with the practical considerations of prehospital care. Therefore, maintaining the fracture in the position found, unless adjustment is necessary for safe transport, is a reasonable and evidence-based strategy 1.
From the Research
Optimal Splint Position for Boxer's Fracture
The optimal splint position for a boxer's fracture (metacarpal fracture) can be determined based on the following evidence:
- A cast can be used for a short period in full extended position of fingers and flexion in metacarpo-phalangeal joint in 60 - 90 degrees 2
- Twin-tape fixation allows functional treatment after soft-tissue swelling has disappeared 2
- A combination of malleable aluminium alloy splint and plaster of Paris cast can be used for external immobilisation 3
- A soft wrap and buddy taping can be used to treat boxer's fractures with volar angulation between 30 to 75 degrees, allowing immediate free range of motion 4
- An ulnar gutter splint is a simple and proven method for immobilizing boxer's fractures 5
Key Considerations
When determining the optimal splint position, the following factors should be considered:
- The degree of volar angulation: fractures with angulation of up to 75 degrees can be treated with soft wrap and buddy taping 4
- The presence of joint displacement, malrotation, or shortening: conservative treatment is recommended if there is no joint displacement, malrotation, displacement of over 30 degrees ad axim and shortening of over 5 mm 2
- The stability of the fracture: early functional treatment should be carried out in stable, not displaced fractures 2