reducing Boxer’s fracture in ED

10 Jan

BOXER’S FRACTURE

= metacarpal neck fracture, typically refers to 5th/little/pinky finger (sometimes the 4th/ring finger)

Usually result in dorsal angulation.

The fourth MC can tolerate 30 degrees of angulation

the fifth MC can tolerate up to 40 degrees without adverse outcomes. (Although some may argue 30 degrees on the fifth is the limit.)

 

If under that angulation, usually can be reduced in the ED.

 

HOW TO REDUCE:

flex the finger at the MCP and PIP joints and apply pressure to the finger between the PIP and DIP joints with pressure on the dorsum of the hand behind the injury at the same time. (of course after a hematoma block).

 

Should feel the reduction. May be discharged with an ulnar gutter splint with 4/5 fingers flexed at the MCP and f/u with hand clinic.

 

Submitted by J. Rothstein.

 

 References: http://www.wheelessonline.com/ortho/boxers_fracture_metacarpal_neck_1; picture

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