• 
• 

Three Part Question

In [an adult patient with an uncomplicated fifth metacarpal neck fracture] is [buddy strapping as effective as plastering] for [immobilisation]?

Clinical Scenario

A 25 year old male presents to the Emergency Department after punching a wall. He has a closed, minimally displaced fracture of the neck of the fifth metacarpal on his right hand. There is no rotational deformity of the little finger. The patient is not keen on being in plaster and asks is there another option?

Search Strategy

PubMed (All): Fifth Metacarpal Fractures. English.
The references of relevant papers were also searched.
272 Abstracts titles were scanned for relevance.
15 initial titles, had the papers read. Of this 4 relevant papers were found where buddy strapping/neighbour strapping was used.

Search Outcome

The 4 papers consisted of a Cochrane review, 2 randomised control trials and 1 case series.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Pellatt R, Formin I, Pienaar C, Bindra R, Thomas M, Tan E, Mervin C, Zhang P, Kijzers G. 8th March 2019 Australia	Adult patients between the ages 18-70 years 126 eligible patients with isolated, uncomplicated fifth metacarpal neck fractures (Boxer's Fractures)	Randomised controlled trail Taken place in two emergency departments in Australia	Primary Outcome : Hand function at twelve weeks using Quick Dash	Quick dash is a validated tool used to evaluate specific upper limb functions. The standard DASH questionnaire is 30 questions long. The Quick DASH is 11 questions long. Patients report their score between 0-100. The higher the score, signifying a greater disability. At 12 weeks in both groups the Quick DASH was 0 (CI 95% 0 to 0)	Potential Selection Bias. There were 41 eligible patients who were not recruited and 34 who declined to participate. The patient demographics between those not included and those included were similar. Therefore it is likely this has minimum impact. Loss to follow up - 21% of patient were lost to follow up. This is a reasonable about of patient to lose to follow up. There this may have had some impact. Blinding: The clinicians nor patients could be blinded in the study. It is unlikely the primary outcomes would have been affected by this, but the secondary ones may have been. The trial was designed as a superiority trial. If designed as a non inferiority trial ( is buddy strapping no worse than plastering boxer's fractures) then the sample size would have been smaller.
			Secondary Outcome: Pain at 12 weeks	No patients were in pain at 12 weeks
			Secondary Outcome: Satisfaction score at 12 weeks	Both groups reported high satisfaction
			Secondary Outcome: Missed work	Buddy strapped patients missed no work. The plaster group missed a median of 2 days work.
			Secondary Outcome: Missed hobbies or sports	No difference between the two groups. Both missed activities.
			Secondary Outcome: Quality of Life	No difference between the two groups.
van Aaken J, Fusetti C, Lucchina S, Brunetti S, Beaulieu JY, Gayet-Ageron A, Hanna K, Shin AY January 2016 Switzerland and United States	68 Skeletally Mature patients	Multi centre, prospective, randomised study conducted in four different hospitals in Switzerland and the United States of America.	Primary Outcome: To compare two methods of nonoperative treatment of 5th metacarpal neck fractures [closed reduction/cast immobilisation (RC) vs soft wrap and buddy tapping of 4th and 5th metacarpal (SW)] using the Quick DASH score at 4 months post intervention.	After adjustment for main confounders, the difference between both groups in the quickDASH between baseline and 4 months was -10.4 [(95 % CI): -27.0; +6.2] confirming the noninferiority of SW compared to RC with an upper bound of 95 % CI below the pre-specified +10 points margin.
			Secondary Outcome: Pain at 4 moths	No statistical difference between both groups at 4 months (P = 0.289)
			Secondary Outcome: Satisfaction at 4 moth post intervention.	No statistical difference between both groups at 4 months (P = 0.99)
			Secondary Outcome: Work Days missed	The SW had significantly less days off work than the RC group. Median of 22 days with SW group vs 33 days in RC group. (P=0.03)
			Secondary Outcomes: Multiple technical orthopaedic aspects including flexion at the joint, hyperextension at the joint, power grip and fracture angulation.	Overall there was no statistical difference between each group for any of these aspects.

References

1. Pellatt R, Formin I, Pienaar C, Bindra R, Thomas M, Tan E, Mervin C, Zhang P, Kijzers 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 Jul;74(1):88-97. doi: 10.1016/j.annemergmed.2019.01.032.
2. van Aaken J, Fusetti C, Lucchina S, Brunetti S, Beaulieu JY, Gayet-Ageron A, Hanna K, Shin AY Fifth metacarpal neck fractures treated with soft wrap/buddy taping compared to reduction and casting: results of a prospective, multicenter, randomized trial. Archives of Orthopaedic and Trauma Surgery 2016 Jan;136(1):135-42. doi: 10.1007/s00402-015-2361-0