What is the proper buddy taping technique for a fifth finger fracture using a buddy loop?

Buddy Taping Technique for Fifth Finger Fractures

For uncomplicated fifth metacarpal neck (boxer's) fractures, buddy tape the ring and little fingers together without reduction or casting—this provides equivalent functional outcomes to plaster immobilization while allowing faster return to work and better patient comfort. 1, 2

Indications for Buddy Taping

Buddy taping is appropriate for:

• Fifth metacarpal neck fractures with <70° volar angulation and no rotational deformity 2, 3
• Proximal and middle phalangeal fractures (including displaced fractures after reduction) 4, 5
• Proximal interphalangeal (PIP) joint injuries 6

Proper Buddy Taping Technique

Basic Application Steps

• Tape the injured fifth finger to the adjacent fourth (ring) finger 1, 2
• Place padding material (gauze or cotton) between the fingers to prevent skin maceration and friction injuries 6
• Use hypoallergenic tape to minimize skin reactions 6
• Apply tape in 2-3 locations along the finger length: typically at the proximal, middle, and distal portions, avoiding direct pressure over joints 4
• Ensure the tape is snug but not constrictive—patients should maintain circulation and sensation 6

The "Buddy Loop" Method

While the evidence doesn't specifically detail a "buddy loop" technique by name, the standard approach involves:

• Wrapping tape circumferentially around both fingers together rather than just side-to-side taping 1, 2
• Creating a figure-of-eight pattern can provide additional stability while allowing joint motion 4
• Avoiding tape directly over fracture sites or injured joints when possible 6

Immediate Mobilization Protocol

• Begin active range of motion exercises immediately after taping application 4, 5
• No period of immobilization is required for stable fractures 2, 3
• Patients can return to work significantly faster (11-28 days earlier) compared to casting 2, 3

Duration of Treatment

• Continue buddy taping for 3-4 weeks for most uncomplicated fractures 1, 2
• Patients may remove tape for bathing and reapply, which improves compliance 3
• Follow-up at 3 weeks to assess healing and range of motion 2

Critical Pitfalls and Complications

Common Complications to Monitor

• Skin necrosis and maceration occur in approximately 45% of cases when padding is inadequate 6
• Skin injuries at tape adhesive sites affect 45% of patients 6
• Low patient compliance is reported by 65% of treating physicians 6
• Loss of the metacarpal "knuckle" prominence is cosmetically noticeable but functionally insignificant—patients must accept this trade-off 3

Prevention Strategies

• Always use interdigital padding to prevent skin-to-skin contact 6
• Educate patients on proper reapplication technique if they remove tape for hygiene 3
• Schedule early follow-up (within 1 week) to check for skin complications and reinforce technique 6
• Avoid excessive tape tension that could compromise circulation 6

Contraindications Requiring Alternative Treatment

• Volar angulation >70° requires consideration for reduction and possible surgical referral 2, 3
• Rotational deformity is an absolute contraindication to buddy taping alone 2, 3
• Open fractures require surgical consultation 7
• Joint subluxation or large avulsion fractures (>1/3 articular surface) need surgical evaluation 8, 7

Functional Outcomes

At 12 weeks, buddy taping produces identical functional outcomes to casting with median quickDASH scores of 0 in both groups 1. Patients achieve:

• Full or nearly full range of motion in all studies 1, 2, 4
• No difference in grip strength compared to casting 2
• High patient satisfaction despite residual angulation 3
• No increased risk of nonunion or malunion requiring surgery 4

The radiographic angulation after buddy taping is equivalent to post-reduction casting, as reduction is typically lost by 3 weeks regardless of treatment method 2.