1. Boxer's Fracture Case Study: Scholarly Article Review
Presented by:
Christie Smallwood and Brandi Schexnayder
Orthotics and Prosthetics

2. Case Study
A right hand dominant 20 y/o male sustained 4th and 5th metacarpal fractures (boxer's fracture) after punching a wall. His injury occurred one week ago. MD referred him to occupational therapy for custom orthotic fabrication. What custom orthosis should be fabricated and why?
Ulnar Gutter Orthosis
Ulnar gutter orthoses are indicated in boxers' fractures “with mild angulation and no rotational deformities” taking care to pad bony prominences.

3. Title and Publication Date
Harding, I.J., Parry, D., Barrington, R.L. (2001). The use of a molded metacarpal brace versus neighbor strapping for fractures of the little finger metacarpal neck. Journal of Hand Surgery (British & European Volume), 26(3):
After researching randomized controlled trials on the efficacy of ulnar gutter orthoses, it was found few studies exists indicating usage.
The chosen study is the most comparable (in current existence) to an ulnar gutter splint versus buddy strapping.

4. Methodology/Design Prospective randomized single blind study
Patients with minimally angulated; <40° closed fracture of the little finger metacarpal neck with no rotational deformity or associated injury
After informed consent, patients randomized by hand therapist to tx with metacarpal brace or neighbor strapping by sealed envelope
Sample size: N=73
Group 1; Molded Brace N=42 (5 dropouts)
Group 2; Buddy Strapping N=31 (3 dropouts)

5. Methods cont'
The brace was heat molded contouring to the patients hand while the metacarpal head was supported and held in place by a bandage.
Both groups received patient education, analgesic use and early active mobilization of the MCP and IP joints.
Patient education also included advising participants to engage in ADL's & employment ASAP.

6. Outcome Measures Pain; measured with verbal 0-3 rating scale
Tenderness; measured with 0-3 rating scale
ROM (active & passive); flexion and extension at MCP joint
Patient satisfaction; subjective screen at 3 weeks

7. Results
Group 1; Molded brace group exhibited more remarkable gains in comparison to Group 2; Buddy strapping.
Group 1 displayed:
Less pain P=0.01
Slightly better finger movement P=0.03
More of them returned to work by 3 weeks P=0.007

8. Does this article support use of the modality?
Yes!
The researchers cite there is no agreed upon protocol, but the selected tx should reduce pt. discomfort, allow early return of movement and permit early return to work. This is especially important as this fx occurs commonly in the manual worker.

9. Article support cont'
The patients in the study possessed a less severe boxers fracture than the 20 y/o in the case study. Therefore, a less stable orthosis was utilized.
Our client has a boxers fracture including the 5th and 4th digits. As a result, he requires more support/stability.
Similar to the molded brace, his ulnar gutter orthosis will support MCP joints but will begin at the proximal forearm and extend just beyond the DIP joint including the 5th, 4th, 3rd digits.

10. Level of Evidence Level IV Evidence
No control group; Two intervention groups
Sample size is less than 100
Implications: We need more RCT's indicating orthoses usage in various injuries

11. References
Boyd, A., Benjamin, H., Asplund, C. (2009). Splints & casts: Indications and methods. American Family Physician, 80(5):
Harding, I.J., Parry, D., Barrington, R.L. (2001). The use of a molded metacarpal brace versus neighbor strapping for fractures of the little finger metacarpal neck. Journal of Hand Surgery (British & European Volume), 26(3):