From the Research
Refer a patient with a boxer fracture to an orthopedic or hand specialist if there is significant displacement, rotational deformity, multiple fractures, open fractures, intra-articular involvement, or if the fracture is unstable, as indicated by the most recent study 1. The management of boxer fractures varies depending on the type and severity of the injury. According to the latest study 1, non-operative management is suitable for fractures that are closed, non-displaced, and without angulation or rotation. However, open fractures, fractures with angulation and/or mal-rotation, and fractures with neuro-vascular injury are more suitable for operative management. Some key points to consider when deciding on referral include:
- Significant displacement, which may be defined as angulation greater than 70 degrees, although this may vary depending on the specific fracture and patient factors 1
- Rotational deformity, which can lead to long-term functional impairment if not properly addressed
- Multiple fractures, which may require more complex management and stabilization
- Open fractures, which increase the risk of infection and require prompt surgical intervention
- Intra-articular involvement, which can lead to arthritis and other long-term complications if not properly managed
- Fracture instability, which may require surgical stabilization to ensure proper healing and prevent long-term complications Immediate referral is necessary for open fractures, neurovascular compromise, or compartment syndrome, as these conditions require prompt surgical intervention to prevent serious complications. Patients with functional limitations despite conservative management, those with occupational demands requiring optimal hand function, or cases with delayed presentation (>2 weeks) should also be referred for specialist evaluation, as they may benefit from more advanced management and rehabilitation strategies. While many boxer fractures can be managed conservatively with immobilization using an ulnar gutter splint for 3-4 weeks followed by progressive mobilization, these specific scenarios require specialist evaluation to prevent long-term complications such as malunion, decreased grip strength, and functional impairment. The specialist may recommend surgical intervention, including closed reduction with percutaneous pinning or open reduction with internal fixation, depending on the fracture characteristics and patient factors, as outlined in the most recent study 1.