Review Question - QID 219916

The patient has sustained a 5th metacarpal neck fracture with less than 50 degrees of angulation and a goal to return to work as fast as possible making buddy taping to the adjacent digit the most appropriate treatment course (Answer 3).

Fifth metacarpal neck fractures (Boxer's fracture) are treated nonoperatively when neck angulation is less than 50-70 degrees. Traditional nonoperative management strategies for this fracture pattern included ulnar gutter immobilization for two to three weeks. However, multiple studies have demonstrated that buddy taping of the 4th to the 5th digit with an associated soft wrap provides adequate stability for fracture healing, no associated increases in pain, and similar functional outcomes compared to closed reduction and rigid immobilization with less time off from work.

Aaken et al. reviewed the conservative management of 5th metacarpal neck fractures. The purpose of their prospective randomized trial was to determine if the outcomes of soft wrap and buddy taping were non-inferior to reduction and casting of 5th metacarpal neck fractures with volar angulation of 70 degrees or less. At 4-month follow-up, they found no significant difference between both groups' secondary outcomes of pain, satisfaction with esthetic appearance, mobility of the metacarpophalangeal joint (MCPJ), or power grip. Additionally, the soft wrap and buddy-taping cohort returned to work 11 days earlier than those who underwent reduction and casting. The authors conclude that soft wrap and buddy taping is an adequate form of immobilization to promote healing and earlier return to work in patients with 5th metacarpal neck fractures that have less than 70 degrees of volar angulation and no rotational deformity.

Pellatt et al. compared buddy taping with plaster casting for 5th metacarpal neck fractures. This randomized controlled trial included 97 patients aged 18 to 70 years old. The primary outcome, hand function measured by the quickDASH score at 12 weeks, showed no difference between the two groups (both scored 0). Secondary outcomes, including time off work, pain, and overall health, were also similar, though the buddy-taping group missed fewer workdays. The buddy-taping cohort missed a median value of 0 days, while the plaster immobilization group missed an average of 2 days. The authors conclude that buddy taping is an effective intervention for uncomplicated 5th metacarpal neck fractures.

Figures A and B are plain radiographs demonstrating a 5th metacarpal neck fracture with less than 50 degrees of volar angulation.

Incorrect Answers:
Answer 1 & 2: Ulnar gutter splint or cast application is a rigid form of immobilization that can be utilized to treat 5th metacarpal neck fractures but is associated with later return to work in comparison to buddy taping and soft wrap application.
Answer 4 & 5: Operative intervention is not indicated in this clinical scenario as this patient has a 5th metacarpal neck fracture with less than 50 degrees of volar angulation and no rotational deformity on clinical examination.