Boxer's Fracture - Treatment

Treatment

Once injured, the subject will feel both the swelling and associated pain in the hand. To temporarily help alleviate the pain and swelling, ice must be applied. If there are any open wounds, washing the hand is advised to avoid any sort of infections. Before seeing a physician, the injured hand must remain immobilized and cannot be used to complete tasks. If the broken hand is used, it can cause further damage to the muscles, blood vessels, tendons, ligaments and nerves. It is advised to help with the pain; the subject can take over the counter drugs, such as acetaminophen or ibuprofen.

Some splints would extend from the about the mid-forearm to the fingers, leaving the fingertips exposed. If the injury isn’t bad, doctors can recommend using tape. Here, the fingered is taped to the adjacent finger together, helping limited mobilization. The doctor will recommend what works best, depending on the condition of the injury.

A conservative approach to healing can be attempted for cases with only minor angulation. Angulation is the misalignment of the metacarpal bones. If the injury causes angulation in the 2nd or 3rd metacarpal, this can lead the subject to visiting a hand specialist, where surgery can be a possibility. The surgeons look to see if the bone surpasses 70 degrees. Surgery is recommended if the bones are badly misaligned and the doctor is unable to correct the bones by pulling or pushing. In the surgery, they will place many pins through both parts of the bones so that the bone will heal correctly. Initial reduction is optimally performed by the Jahss maneuver, in which the metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP) are flexed to 90 degrees, causing reduction by tightening of the collateral ligaments of the MCP. Subsequent splinting is performed with the MCP joint remaining flexed to avoid tendon contracture.

Severe angulation requires pins to be put in place and realignment as well as the usual splinting. However, the prognosis on these fractures is generally good, with total healing time not exceeding 12 weeks. The first two weeks will show significantly reduced overall swelling with improvement in clenching ability showing up first. Ability to extend the fingers in all directions appears to improve more slowly. Hard casts are rarely required and soft casts or splints can be removed for brief periods of time to allow for activities such as showers and "airing out" the cast or splinted area so as to avoid skin rotting and permit cleansing of the cast or splinted area. Pain from this injury is generally very mild and rarely requires medications beyond over the counter drugs such as ibuprofen or acetaminophen. Muscle atrophy in isolated areas of 5 to 15 percent should be expected with a rehabilitation period of approximately 4 months given adequate therapy. In the mildest of cases, full rehabilitation status can be achieved within 3 to 4 months.

For smaller angled fractures most discomfort is alleviated by raising the fracture above the heart; after swelling has subsided, if there is no cast, warm water can be used to relieve some of the pain. It is important that when the cast is removed that the hand is gently exercised by attempting the common functions in the hand.