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Forum Name: Bone trauma and fractures

Question: Healing Boxers Fracture


 jfayard - Wed Dec 09, 2009 2:19 pm

I hit a wall last week and has been diagnosed with a "boxer's" fracture. They put me in a cast and referred me to an ortho for another cast in a couple of weeks. This incident happened about a month before I am eligible for health insurance and am currently unisured. I can not afford to go to a specialist. Do you think it would exacerbate the injury if I removed the cast in another week and replaced it with a splint? Provided the swelling is reduced and there appears to be some improved range of motion. The ER Doc said it was limited to the fifth MC at the knuckle? Any advice would be greatly appreciated.
 Dr.M.Aroon kamath - Mon Dec 14, 2009 9:17 am

User avatar Hi,
"Boxer's fracture", bar room fracture or "brawler's fracture" usually occurs at the neck of the metacarpal of the little finger (but can also mean fractures of the necks of the other metacarpals as well).

Mostly some form of immobilisation of the fracture is required.
Two aspects that are usually taken into consideration are
a) the degree of angulation and
b) minimizing axial rotation.

Whatever casting technique is used, it is essential to "buddy tape" the little and ring fingers (with an intervening layer of padding) in order to control axial malrotation of the fracture.

As to how long to keep the cast, the protocols vary between orthopedic surgeons.Also, whether a patient could be followed up at fairly short intervals,the follow-up findings,the degree of angulation and axial rotation.

There are some who would apply a cast for a week and then follow it up with mobiization of the finger.

Another protocol would be to apply a cast for 4-6 weeks and then allow mobilization and intermittent splinting.

So, without first-hand knowledge of the exact type of fracture in your case it may not be possible to offer a plan of management.
Best wishes!

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