Fractures of the metacarpal bones are the most common hand injuries. Fractures through the neck of the 5th metacarpal (little finger hand bone) account for the majority of these. They are known as Boxer’s Fractures, as they are often sustained during a punch. Boxer’s fractures are traditionally managed in plaster, but in recent years there has been some suggestion that to simply ‘tape’ the little and ring fingers together will allow similar recovery with the advantage of full mobilisation. Currently there is not enough evidence to recommend one treatment over another. Potential benefits of buddy taping include: earlier return to work, less time spent in emergency, simple community follow up at the patient’s discretion. There is an economic benefit for the patient (they don’t miss work through being in a cast) and for the hospital (less time in ED and no need for orthopaedic follow up).
Our study is randomised and prospective. We enrol patients in the EDs of Robina and Gold Coast University Hospitals and randomise the patient to either receive a cast or buddy strapping. The patients are followed up in the orthopaedic fracture clinic at 1, 3 and 6 weeks, with phone follow up at 12 weeks. We are measuring hand function (using the quickDASH score of function), pain, satisfaction, economic analysis of return to work and sports, as well as objective strength and movement in the affected hand.
The study will improve the way that we manage a common injury. Patients who previously had to attend multiple busy outpatient clinics will potentially follow up with their GP at their discretion. Where patients would previously have spent 4 weeks in a cast, if buddy taping is effective, they can return to work immediately. This will result in time and resources saved in both the ED (assessment and application of plaster) as well as in orthopaedic outpatients (fewer follow up appointments and no need to replace plasters). Our aim is to optimise the care of our patients in a busy and time-pressured environment, and if the functional outcome is the same in both arms, we can choose the arm that most benefits the long-term economic, and social outcomes.
This was the first Australasian study into Boxer’s Fractures. The research team found that buddy taping a boxer’s fracture had the similar outcome to a plaster cast at 12 weeks. They advocated a minimal intervention such as buddy taping for uncomplicated boxer’s fractures.
The research is expected to lead to policy changes at the Gold Coast University Hospital and potentially other hospital emergency departments.
- Pellatt R., Fomin I., Pienaar C., Bindra R., Thomas M., Tan E., Mervin C., Zhang P., Keijzers G., “Is Buddy Taping as Effective as Plaster Immobilization for Adults With an Uncomplicated Neck of Fifth Metacarpal Fracture? A Randomized Controlled Trial”, Annals of Emergency Medicine, 2019. doi.org/10.1016/j.annemergmed.2019.01.032 [epub 8 March 2019].
-“Is minimal intervention as effective as routine immobilisation in adults with an uncomplicated closed neck of 5th metacarpal fracture? The Buddy study”, Australasian College for Emergency Medicine Annual Scientific Meeting, November 19th-23rd 2017, Sydney, Australia. Oral presentation
-Gold Coast Health Research Week Conference, 28th-30th November 2017, Gold Coast, Australia. Oral presentation
-“Is buddy taping as effective as routine plaster immobilisation in adults with an uncomplicated closed neck of 5th metacarpal fracture? A randomised controlled trial”, Australian Orthopaedic Association Annual Scientific Meeting (7-11 October 2018, Perth). Oral presentation
Trainee Grant Scheme
Dr Richard Pellatt
A/Prof Gerben Keijzers
Dr Ezekiel Tan
Dr Michael Thomas
Prof Randy Bindra
A/Prof Gerben Keijzers
Dr Martin Smith