What is the treatment for a boxer's fracture?

Boxer's Fracture Treatment

For uncomplicated boxer's fractures with angulation ≤50-70 degrees and no rotation, immediate mobilization with a pressure bandage or ulnar gutter splint for 1 week followed by early functional rehabilitation produces excellent outcomes and is superior to prolonged cast immobilization.

Initial Assessment

Evaluate for surgical indications first:

• Assess degree of volar (palmar) angulation on upright radiographs, which better demonstrate displacement than supine films 1
• Check for rotational deformity by examining finger cascade and nail plate alignment
• Document multiple fractures, which require surgical intervention 1
• Look for open fractures, severe soft tissue injury, or fight bite contamination requiring antibiotics

Treatment Algorithm Based on Angulation

Angulation ≤50-70 degrees WITHOUT rotation:

Non-operative treatment is indicated and produces good functional outcomes 2, 3

Immobilization options (choose one):

• Pressure bandage for 1 week followed by immediate mobilization - this is the preferred approach as it results in satisfied patients with good ROM, no increased pain, and faster return to function 3
• Ulnar gutter splint for 1-3 weeks if patient compliance or pain control is a concern 4, 2
• Rigid splinting is preferred over removable splints for displaced fractures 1

Key evidence: A prospective randomized trial demonstrated that immediate mobilization after 1 week of pressure bandage produced equivalent ROM, satisfaction, pain scores, and return to work/hobby compared to 3 weeks of cast immobilization for fractures with up to 70 degrees angulation 3

Angulation >70 degrees OR any rotational deformity:

Closed reduction is required 5

• Use malleable aluminum alloy splint combined with plaster of Paris cast after reduction 5
• This method shows significant improvement in fracture angulation at 3-5 week follow-up 5

Rehabilitation Protocol

Early mobilization is critical for optimal outcomes:

• Begin muscle strengthening exercises early 1
• Continue long-term hand exercises 1
• Educate patients about pain management strategies 1
• Monitor for signs of complications including malrotation, stiffness, or infection 1

Common Pitfalls to Avoid

• Do not immobilize for prolonged periods (>3 weeks) - this increases stiffness without improving outcomes 3
• Do not use figure-of-eight bracing - splinting is preferred for phalangeal and metacarpal fractures 1
• Do not reduce fractures with <70 degrees angulation - reduction provides no benefit for ROM in this range 3
• Always check for rotation - even minimal rotational deformity is unacceptable and requires reduction, as it causes finger overlap during flexion

Follow-up

• Most patients with uncomplicated fractures ≤50 degrees angulation can be discharged without routine follow-up and return to work immediately 2
• For reduced fractures or those with 50-70 degrees angulation, follow-up at 1-2 weeks to assess alignment and begin mobilization
• Final assessment at 6-12 weeks to confirm ROM and functional recovery 3