A 19-year-old boxer punches a wall and presents with pain and swelling over the dorsum of the little finger. X-ray shows a fracture of the neck of the fifth metacarpal with 30 degrees of dorsal angulation and no rotational deformity. The most appropriate management is:
- A Open reduction and plate fixation through a dorsal approach
- B Immediate amputation consideration due to vascular compromise
- C Closed reduction and ulnar gutter cast with the metacarpophalangeal joints flexed ✓
- D Transverse Kirschner wire fixation into the fourth metacarpal under anaesthesia
Correct answer: C. Closed reduction and ulnar gutter cast with the metacarpophalangeal joints flexed
Explanation
A boxer's fracture is a fracture of the neck of the fifth metacarpal. Because the fourth and fifth carpometacarpal joints have substantial mobility, dorsal angulation up to about 40 degrees remodels well and does not impair function, so closed reduction with an ulnar gutter splint holding the MCP joints flexed is adequate. Rotational deformity, unlike angulation, must be corrected because it causes scissoring of fingers. Fixation is reserved for unacceptable angulation, rotation, or unstable reductions.
Reference: Green's Operative Hand Surgery, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.