“The radiograph shows a fracture of the fifth metacarpal head, commonly known as a boxer’s fracture. There is only slight volar angulation and no displacement. The proper treatment for this fracture is an ulnar gutter splint, which immobilizes the wrist, hand, and fourth and fifth digits. The wrist should be positioned in slight extension with the metacarpophalangeal joint in 70°–90° of flexion and the proximal interphalangeal joint in 5°–10° of flexion. Generally, 3 or 4 weeks of continuous splinting is adequate for healing.
Surgical pinning is indicated in cases of significant angulation (35°–40° or more of volar angulation) or in fractures with significant rotational deformity or displacement. The other options listed are not appropriate treatments for this injury. This injury most commonly results from “man-versus-wall” pugilistics, but other mechanisms of injury are possible.” ABFM critique 2017
Further Reading / Reference
Boyd AS, Benjamin HJ, Asplund C: Splints and casts: Indications and methods. Am Fam Physician 2009;80(5):491-499.
Abraham MK, Scott S: The emergent evaluation and treatment of hand and wrist injuries. Emerg Med Clin North Am 2010;28(4):789-809