At what week can buddy taping (taping to an adjacent finger) be considered for a fifth metacarpal neck fracture?

Transitioning to Buddy Taping for Fifth Metacarpal Neck Fractures

Buddy taping can be initiated at 2-4 weeks after initial treatment of a fifth metacarpal neck fracture, as fractures typically show healing by this time and functional recovery is enhanced with earlier mobilization.

Initial Management and Healing Timeline

• Fifth metacarpal neck fractures (boxer's fractures) account for approximately 20% of all hand fractures and can be managed conservatively in most cases 1
• Fracture healing occurs progressively, with radiographic evidence of healing visible in 37% of metacarpal fractures at 1 month and 100% by 2 months in patients who complete follow-up 2
• Initial management typically involves either cast immobilization or functional taping depending on fracture characteristics and displacement 3

Transition to Buddy Taping

Timing Considerations:

• Transition to buddy taping can begin at 2-4 weeks after initial treatment, when early callus formation is present 2, 4
• Patients treated with functional taping from the beginning show significantly earlier functional recovery compared to those in casts 4
• By 4 weeks post-injury, most metacarpal fractures have sufficient stability to allow protected motion with buddy taping 2

Clinical Decision Points:

• Radiographic assessment should confirm early healing before transitioning to buddy taping 2
• Absence of significant pain with gentle palpation at the fracture site indicates appropriate timing for transition 3
• Minimal to no motion at the fracture site on clinical examination is a prerequisite for transitioning to buddy taping 2

Benefits of Early Transition to Buddy Taping

• Earlier transition to buddy taping results in faster functional recovery and earlier return to work (approximately 11 days sooner than with prolonged casting) 3
• Range of motion recovers to approximately 89% at 6 weeks and 100% by 3 months compared to the uninjured side when early mobilization is permitted 5
• Grip strength progressively improves from 61% to 85% of the uninjured side over 3 months with protected mobilization 5

Monitoring After Transition

• After transitioning to buddy taping, patients should be monitored for:
  • Secondary displacement, which occurs in approximately 11% of cases but rarely requires intervention 2
  • Rotational alignment, which should be maintained throughout the healing process 1
  • Progressive improvement in grip strength and range of motion 5

Special Considerations

• Fractures with initial palmar angulation ≤70° and no rotational deformity can be safely managed with buddy taping with outcomes comparable to reduction and casting 3
• Patients should be counseled that accepting some degree of palmar angulation does not significantly impact functional outcomes but may affect the cosmetic appearance of the knuckle 3
• Buddy taping should be continued for a total of 4-6 weeks from the time of injury to ensure complete healing 2, 4

Pitfalls to Avoid

• Transitioning too early (before 2 weeks) may risk secondary displacement in unstable fractures 2
• Failing to properly educate patients on buddy taping technique may lead to inadequate protection 3
• Neglecting to monitor for rotational deformity, which is more functionally limiting than palmar angulation 1
• Prolonged immobilization beyond 4 weeks can lead to unnecessary stiffness and delayed functional recovery 4