A boxer’s fracture is a fracture of the neck of the metacarpal bone at the end closest to the knuckle. Immediate mobilization gives good results in boxer's fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization.The bones of the hand consist of the carpal, or wrist bones the metacarpal bones, which lie between the wrist bones and the finger bones and the phalangeal bones, which form the fingers. A clinical and radiographical study of 64 cases.īiomechanical effects of angulated boxer's fractures. Intra-articular fractures at the base of the fifth metacarpal. Ĭonservative treatment of boxer's fracture: a retrospective analysis. įractures of the metacarpal neck of the little finger. Immediate mobilization of fractures of the neck of the fifth metacarpal. Year Book: Functional Treatment of Metacarpal Fractures: 100 Randomized Cases With or Without Fixation. no matter what casting technique is used, it is essential to "buddy tape" the little and ring fingers (with an intervening layer of cast padding) in order to control fracture malrotation Fractures of the fifth metacarpal neck: is reduction or immobilisation necessary? Biomechanical effects of angulated boxer's fractures. on AP view, little or no anglation should be accepted, since this indicates mal-rotation of the digit July 1999), 30 deg of angulation resulted in loss of 22% of finger ROM in the report by Ali et al (JHS Vol 24-A. on lateral view if angulation > 30-40 deg, a functional deficit (pseudoclawing) may result - consider percutaneous pin fixation. flexed metacarpal is directed dorsally, which effects reduction of metacarpal head by correction of volar angulation MP joint is flexed 90 deg to produce tightening of MP collateral ligaments because collateral ligaments are the only remaining attachment to metacarpal head, collaterals must be placed in a tightened position to control distal fragment and achieve reduction may have cosmetic deformity, but good function clawing results from the palmar displacement of the metacarpal head & resulting imbalance of extrinsic tendons when displaced, angulate with dorsal angulation at frx line & distal metacarpal head displaces palmarward normal metacarpal neck angle is about 15 deg & therefore a measured angle on film of 30 deg actually = 15 deg true lateral radiograph is necessary with these fractures in order to measure the angle of displacement of the distal fragment in this injury, impact is recieved directlly on metacarpal head, producing frx thru joint surface transverse metacarpl shaft frx this frx may be ammenable to a 4 holed plate ring metacarpal provides 10-15 deg of mobility little finger CMC articulation allows flexion extension arc of 20-30 deg in addition to a rotatory motion facilitating little finger opposition to thumb if joint is allowed to remain in hyperextension, collateral ligaments will shorten, leading to limited MCP flexion metacarpal head tilts volarly causing joint to lie in hyperextension & collateral ligaments become slack only collateral ligaments, remain attached to the proximal phalanx, & therefore metacarpal head is freed from any proximal stabilizing influence metacarpal neck frx involving little finger
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