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Does a boxers fracture need to be plated?

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My son recenty broke his left hand about 1/2 inch behind the knuckle. They called it a boxer's fracture. It was set and then x-rayed a week later and it came out of place again. I was reset today and cast. Do patients in your clinic usually have surgery to have these pinned, or are they allowed to heal without correction and sometimes slightly misaligned? The Dr. also told me that he would no longer have a prominent knuckle due to this but the functionality of the hand would not be compromised. My son also like to play piano which I am concerned about.

Thx,

Steve

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The books say that a Boxer's fracture can have 40 degrees of angulation. That would be unacceptable in nearly all the other bones of the body. Pinning it would make it look better, but function is usually excellent anyway.

Having said that most people opt to have the bone set right in the USA in 2007. So usually I reduce it and pass two pins directly through the skin into the 5th metacarpal, and passing the pins into the stable fourth metacarpal. By doing this the fourth metacarpal becomes the "plate" and the pins act as the "screws" The pins can be removed in the clinic at four weeks.

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I did a lot of reading and looked at some xrays. I wish I knew how to measure angulation. I'm not sure if I should push for surgery or not. I don't see any rotation in the xray. The head of the bone is definitely tipped forward.

Dr.'s don't like to be prodded and questioned and I don't tend to take anyone's word with out investigating myself. I'm going to try to speak with the surgeon on Tues. instead of the staff PA. I want a second opinion and maybe a third. I'm sure I can get what I want but I just have to be careful to ask for the right thing. I want my son to be able to do more than ride his dirt bike when this is over. He needs to get back to the piano too.

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Saw the PA again today and talked to the doc briefly. 35 degrees of angulation and no rotation with perfect alignment. They don't want to do anything stating plating or pins can cause stiffness later on. I don't buy it totally though. I can't see where removeable K wires would cause long term stiffness. I'm working on finding a hand specialist for a second opinion.

One thing is for sure. He is missing out on some good riding weather.

Thx.

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Buy a SWA ticket to Houston. You need to be here for 24 hours. This really isn't a rocket science problem, except in your area.

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