Boxer s fracture treated by boxers cast vs. k-wire fixation

Introduction: Despite being one of the most common injuries in orthopaedics, accounting for about 1/10th of all fractures and up to 2/5^th of all hand fractures, the treatment modalities of 5th metacarpal head fractures are controversial in the literature, ranging from conservative management in most cases to minimally invasive surgeries using k-wires and screws.

Material and Methods: This comparative study was carried out by assessing patients with fractures of the neck of the 5^th metacarpal admitted to D Y Patil Medical College, Hospital and Research Centre from July 2020 to March 2021. 20 patients qualified for the inclusion criteria, 10 being in one group and 10 in the other. K-wire fixation was done for the management of the 5^th metacarpal neck fracture in one group while the other group was managed conservatively (boxer’s cast). The groups were classified according to age, sex, mechanism of injury etc. The mean time between getting hospitalized and commencement of surgery (in cases of k wire fixation) was 2 days.

Discussion: The most common age group was found to be 31-40 (80%), with a male predominance of 95%, right to left side ratio of 17:3. On tabulating the data, after three months of follow up, we discovered there was no significant difference in the TAM (total active movement) between the affected and unaffected hand when k-wire fixation was used. There was a certain degree of malrotation in patients treated by conservative management. Overall, cases with a neck-shaft angle of more than 40 degrees seemed to show better results when treated by k-wire fixation but when integrated with patient satisfaction, cases with a neck-shaft angle of fewer than 30 degrees yielded good results when treated by boxer’s cast.

Conclusion: When the neck-shaft angle is greater than 40-45 degrees, k-wire fixation is a better alternative to a boxer’s cast in the treatment of a boxer’s fracture.