Jan van Aaken1, Cesare Fusetti2, Stefano Luchina3, Stefania Brunetti2, Jean-Yves Beaulieu4, Angèle Gayet-Ageron4, Kathryn Hanna5, Alexander Y Shin6, Eric Hofmeister5. 1. University Hospital of Geneva (HUG), Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland. Jan.vanaaken@hcuge.ch. 2. Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland. 3. Ente Ospedaliero Cantonale (EOC), Locarno, Switzerland. 4. University Hospital of Geneva (HUG), Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland. 5. Naval Medical Center in San Diego, San Diego, USA. 6. Mayo Clinic, Rochester, USA.
Abstract
INTRODUCTION: The majority of fifth metacarpal neck fractures (boxers fracture) are treated conservatively without surgery. The purpose of this prospective, randomized, multicenter trial was to determine if the outcomes of soft wrap and buddy taping (SW) was noninferior to reduction and cast (RC) in boxer's fracture with palmar angulation ≤70° and no rotational deformity. MATERIALS AND METHODS:Sixty-eight patients with similar characteristics were prospectively enrolled and randomized at four institutions. Our primary outcome was measured by the shortened Disabilities of the Arm, Shoulder and Hand (quickDASH) questionnaire at 4 months. Noninferiority was claimed if there was no more than +10 points difference in the quickDASH. Other secondary radiographic and clinical outcomes were measured. RESULTS: At 4 months, mean difference in the quickDASH between the two groups was -10.4 (95 % confidence interval, -27.0; +6.2) which was under the pre-specified margin. There was no significant difference between both groups' secondary outcomes of pain, satisfaction with the esthetic appearance, mobility of the metacarpophalangeal-joint at flexion and extension, or power grip. Increased fracture angulation, as measured on follow-up radiographs, was not significantly different between both groups. The degree of palmar fracture angulation was not related to work leave or profession. Duration of time off from work was 11 days shorter in SW compared to RC (P = 0.03). CONCLUSION: This study supports the use of soft wrap and buddy taping for treatment of boxer's fracture with palmar angulation ≤70° and no rotational deformity. Although there was no statistical difference in satisfaction with the esthetic appearance, the patient must be willing to accept the loss of the "knuckle" with this treatment method.
RCT Entities:
INTRODUCTION: The majority of fifth metacarpal neck fractures (boxers fracture) are treated conservatively without surgery. The purpose of this prospective, randomized, multicenter trial was to determine if the outcomes of soft wrap and buddy taping (SW) was noninferior to reduction and cast (RC) in boxer's fracture with palmar angulation ≤70° and no rotational deformity. MATERIALS AND METHODS: Sixty-eight patients with similar characteristics were prospectively enrolled and randomized at four institutions. Our primary outcome was measured by the shortened Disabilities of the Arm, Shoulder and Hand (quickDASH) questionnaire at 4 months. Noninferiority was claimed if there was no more than +10 points difference in the quickDASH. Other secondary radiographic and clinical outcomes were measured. RESULTS: At 4 months, mean difference in the quickDASH between the two groups was -10.4 (95 % confidence interval, -27.0; +6.2) which was under the pre-specified margin. There was no significant difference between both groups' secondary outcomes of pain, satisfaction with the esthetic appearance, mobility of the metacarpophalangeal-joint at flexion and extension, or power grip. Increased fracture angulation, as measured on follow-up radiographs, was not significantly different between both groups. The degree of palmar fracture angulation was not related to work leave or profession. Duration of time off from work was 11 days shorter in SW compared to RC (P = 0.03). CONCLUSION: This study supports the use of soft wrap and buddy taping for treatment of boxer's fracture with palmar angulation ≤70° and no rotational deformity. Although there was no statistical difference in satisfaction with the esthetic appearance, the patient must be willing to accept the loss of the "knuckle" with this treatment method.
Authors: Christian K Spies; Martin Langer; Bernd Hohendorff; Lars P Müller; Johannes Oppermann; Frank Unglaub Journal: Oper Orthop Traumatol Date: 2019-09-05 Impact factor: 1.154
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