Boxer's Fractures

[suckstobeme]

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Do you guys spend a lot of time reducing boxer's fractures? I had one the other day, pretty angulated, but kinda borderline for the "maximum tolerated angulation" that's listed in the ortho books. There was a little rotational deformity. The thing is, I'm lucky to have a very active Hand service that will see people the next day. So, I end up not pushing on it too much and putting it in a splint and sending it the next day to clinic. I've tried reducing many during my residency, but when I followed up on them they always come out by the time they get to ortho anyway, so what's the point of reducing them.

Do you guys push on a lot of Boxer's fractures? Do you have a lot of luck?

 

[kungfufishing]

I don't - often futile rarely successful

 

[WilcoWorld]

When it comes to an angulated Boxer's I find that good splint placement (wrist in about 30 degrees of extension, fingers in 90 degrees of flexion) does more to get things looking the way Ortho likes 'em to then reduction attempts do.

Any rotational deformity can lead to severe functional impairment, however, so if there's a significant component of that it must be reduced or followed-up quickly.

All that being said, if you can get hand follow-up in one day it probably doesn't matter what you do in the ED, aside from making sure there's no associated fight bite.