Boxer's fractures--conservative or operative management?

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Traumatology

Background:

• Isolated closed fractures of the fifth metacarpal neck are common injuries.
• Treatment options include conservative management and surgical intervention.
• Optimal management strategies require further investigation to balance functional and cosmetic outcomes.

Purpose of the Study:

• To compare the outcomes of conservative versus operative treatment for closed fifth metacarpal neck fractures.
• To evaluate functional recovery, cosmetic results, and patient satisfaction.
• To identify any correlation between fracture alignment and functional disability.

Main Methods:

• A prospective study of 63 patients with isolated closed fifth metacarpal neck fractures.
• Forty patients were recalled and divided into conservative (25) and operative (15) groups.
• Statistical comparison of functional (joint motion, grip strength) and cosmetic outcomes (dorsal angulation, rotatory malalignment, extensor lag).

Main Results:

• All patients achieved good subjective and objective results, with no long-term pain or dissatisfaction.
• Full joint motion and normal grip strength were regained in all patients.
• The operative group showed significantly less dorsal angulation, but with longer rehabilitation. Mild rotatory malalignment was present in both groups, with less extensor lag in the conservative group.

Conclusions:

• Both conservative and operative treatments are effective for closed fifth metacarpal neck fractures.
• Surgical intervention improves cosmetic results regarding dorsal angulation but necessitates extended rehabilitation.
• Failure to correct dorsal angulation does not appear to compromise functional outcomes.