Boxer’s fracture cast or splint. Boxer’s Fracture: Diagnosis, Treatment, and Management of Fifth Metacarpal Fractures

22.02.202120.07.2023 by alexxlab

What are the key aspects of boxer’s fracture diagnosis. How is a boxer’s fracture treated. What are the complications of fifth metacarpal fractures. When is surgery necessary for a boxer’s fracture. How long does recovery from a boxer’s fracture take.

Содержание

Understanding Boxer’s Fracture: Causes and Epidemiology

A boxer’s fracture, also known as a fifth metacarpal neck fracture, is a common hand injury that occurs when the neck of the fifth metacarpal bone breaks. This injury typically results from direct trauma to a clenched fist, such as punching a hard surface.

The incidence of metacarpal neck fractures in the United States is approximately 13.6 per 100,000 person-years. Metacarpal fractures account for 40% of all hand fractures, with fifth metacarpal neck fractures specifically representing 10% of hand fractures.

Who is most at risk for a boxer’s fracture? Males are five times more likely than females to experience this injury, with the highest incidence occurring in males aged 10 to 29. These fractures commonly occur at home or during sporting events.

Mechanisms of Injury

Punching a hard surface with a clenched fist
Direct trauma to the dorsum of the hand
Axial pressure applied to the metacarpal bone

Unlike many other hand and wrist fractures, a boxer’s fracture typically does not result from falling onto an outstretched hand.

Anatomy and Pathophysiology of Fifth Metacarpal Fractures

To understand the nature of a boxer’s fracture, it’s essential to grasp the anatomy of the fifth metacarpal bone and the surrounding structures. The fifth metacarpal consists of four main parts: the head (distal end), neck, body, and base (proximal end).

When direct trauma occurs to a clenched fist, the axial load transfers energy to the metacarpal bone, causing fractures most commonly at the neck. This typically results in apex dorsal angulation, partly due to the forces exerted by the interosseous muscles.

Key Anatomical Considerations

Interosseous muscles: Originate from metacarpal shafts and insert onto proximal phalanges
Collateral ligaments: Join metacarpal bones to proximal phalanges
Adjacent arteries and nerves: Can be injured in severely displaced fractures

Why is proper splinting crucial for boxer’s fractures? The metacarpophalangeal (MCP) joints should be splinted in flexion to prevent shortening of the collateral ligaments, which are taut in flexion and more slack in extension. This positioning, known as intrinsic plus positioning, helps minimize the risk of loss of motion.

Clinical Presentation and Physical Examination

Patients with boxer’s fractures typically present with specific symptoms and signs that help in diagnosis. Understanding these clinical features is crucial for healthcare providers to make an accurate assessment and initiate appropriate treatment.

Common Symptoms and Signs

Dorsal hand pain
Swelling over the affected area
Possible deformity of the hand
Limited range of motion in the affected finger

How should a physical examination for a potential boxer’s fracture be conducted? A comprehensive physical exam should include:

Inspection of the hand for visible deformities or swelling
Palpation of the affected area for tenderness and crepitus
Assessment of range of motion in all fingers
Evaluation of neurovascular status, including sensation and capillary refill
Examination for rotational deformity by having the patient flex their fingers

It’s important to note that a thorough examination may be challenging due to pain and swelling. In such cases, a regional anesthetic block may be necessary to facilitate a more detailed assessment.

Diagnostic Imaging for Boxer’s Fractures

Accurate diagnosis of a boxer’s fracture often requires imaging studies to confirm the presence and characteristics of the fracture. These imaging techniques help determine the severity of the injury and guide treatment decisions.

X-rays: The Primary Diagnostic Tool

X-rays are the most commonly used and initial imaging modality for suspected boxer’s fractures. What views are typically obtained for a thorough assessment?

Posteroanterior (PA) view
Lateral view
Oblique view

These views allow healthcare providers to evaluate the fracture’s angulation, displacement, and any associated injuries. The lateral view is particularly important for assessing the degree of angulation at the fracture site.

Advanced Imaging Techniques

In some cases, additional imaging studies may be necessary for a more detailed evaluation:

CT scan: Provides detailed 3D images of the fracture, useful for complex cases or surgical planning
MRI: May be used to assess soft tissue injuries or occult fractures not visible on X-rays

When are advanced imaging techniques typically employed? These are usually reserved for cases where standard X-rays are inconclusive or when there’s suspicion of associated injuries that require further investigation.

Treatment Options for Boxer’s Fractures

The management of boxer’s fractures varies depending on several factors, including the fracture characteristics, associated injuries, and patient-specific considerations. Treatment options range from conservative management to surgical intervention.

Conservative Management

For many boxer’s fractures, conservative treatment is sufficient. What are the key components of non-operative management?

Immobilization: Typically using an ulnar gutter splint
Pain management: NSAIDs and/or acetaminophen
Ice application: To reduce swelling and pain
Elevation of the affected hand

Immobilization with an ulnar gutter splint is often the definitive treatment for closed, non-displaced fractures without significant angulation or rotation. The splint should be applied with the MCP joints in flexion to maintain proper ligament length.

Surgical Intervention

In some cases, surgical treatment may be necessary. When is surgery typically indicated for boxer’s fractures?

Open fractures
Significantly angulated fractures (generally >40-50 degrees)
Malrotated fractures
Fractures with associated neurovascular injuries
Multiple metacarpal fractures

Surgical options may include:

Closed reduction and percutaneous pinning
Open reduction and internal fixation (ORIF)
External fixation (rarely used)

The choice of surgical technique depends on the specific fracture pattern, associated injuries, and surgeon preference.

Complications and Prognosis of Boxer’s Fractures

While most boxer’s fractures heal well with appropriate treatment, complications can occur. Understanding potential complications and prognosis is crucial for both healthcare providers and patients.

Potential Complications

What are the most common complications associated with boxer’s fractures?

Malunion: Improper healing leading to deformity or functional impairment
Stiffness: Limited range of motion in the affected finger
Tendon adhesions: Resulting in reduced finger mobility
Neurovascular injury: Damage to nearby nerves or blood vessels
Infection: Particularly in open fractures or following surgery
Complex regional pain syndrome: A rare but serious complication

How can these complications be minimized? Proper initial management, adherence to treatment protocols, and appropriate follow-up care are essential in reducing the risk of complications.

Prognosis and Recovery

The prognosis for boxer’s fractures is generally good, with most patients achieving full recovery and return to normal function. However, the recovery timeline can vary depending on several factors:

Severity of the initial injury
Treatment method (conservative vs. surgical)
Patient compliance with treatment and rehabilitation
Individual healing rates

What is the typical recovery timeline for a boxer’s fracture? Most patients can expect:

4-6 weeks of immobilization for conservative treatment
6-8 weeks for surgical cases before returning to light activities
3-4 months before returning to full activities or contact sports

It’s important to note that even with proper treatment, some patients may experience residual stiffness or mild deformity, although this rarely causes significant functional impairment.

Rehabilitation and Return to Activities

Rehabilitation plays a crucial role in the recovery process following a boxer’s fracture. A well-designed rehabilitation program can help restore function, strength, and range of motion in the affected hand.

Phases of Rehabilitation

What are the key phases of rehabilitation for a boxer’s fracture?

Early mobilization: Gentle exercises to prevent stiffness, typically beginning 3-4 weeks after injury or surgery
Range of motion exercises: Focusing on MCP, PIP, and DIP joints
Strengthening exercises: Progressive resistance training for hand and finger muscles
Functional training: Activities that mimic daily tasks and sport-specific movements

The specific timeline and progression of rehabilitation will depend on the individual case and should be guided by a hand therapist or physical therapist.

Return to Activities

How should patients approach returning to normal activities and sports following a boxer’s fracture? A gradual return to activities is recommended, with considerations including:

Pain levels: Activities should not cause significant pain
Range of motion: Near-normal range of motion should be achieved
Strength: Hand strength should be comparable to the uninjured side
Sport-specific requirements: Additional conditioning may be necessary for certain activities

Patients should work closely with their healthcare provider and rehabilitation team to determine the appropriate timing for returning to specific activities. In some cases, protective splinting or taping may be recommended during the initial return to sports or high-risk activities.

Prevention Strategies for Boxer’s Fractures

While not all boxer’s fractures can be prevented, certain strategies can help reduce the risk of these injuries, particularly in high-risk populations or activities.

General Prevention Measures

What are some effective ways to prevent boxer’s fractures?

Education: Raising awareness about the mechanisms of injury and proper hand protection
Anger management: Addressing underlying factors that may lead to punching behaviors
Proper technique: Training in correct punching technique for those involved in combat sports
Equipment use: Utilizing appropriate hand wraps and gloves during boxing or martial arts training
Workplace safety: Implementing safety measures in occupations with high hand injury risk

Sport-Specific Prevention

For individuals involved in combat sports or activities with a high risk of hand injuries, additional prevention strategies may include:

Regular hand conditioning exercises to strengthen bones and soft tissues
Use of padded gloves or hand protection during training and competition
Proper warm-up routines to improve hand and wrist flexibility
Gradual progression in training intensity to allow for adaptation of hand structures

By implementing these prevention strategies, individuals can significantly reduce their risk of experiencing a boxer’s fracture and other hand injuries.

Fifth Metacarpal Fractures – StatPearls

Continuing Education Activity

Metacarpal fractures account for 40% of all hand fractures. A fracture of the neck of the fifth metacarpal, or boxer’s fracture, named for the classic mechanism of injury in which direct trauma is applied to a clenched fist, is the most common, representing 10% of all hand fractures. Treatment for a boxer’s fracture varies based on whether the fracture is open or closed, the degree of angulation, rotation, and other concomitant injuries. Immobilization with an ulnar gutter splint may be the definitive treatment for closed, non-displaced fractures without angulation or rotation, while open fractures, significantly angulated or malrotated fractures or those involving injury to neurovascular structures require referral to a hand surgeon. This activity reviews the etiology, presentation, evaluation, and management of boxer’s fracture, and reviews the role of the interprofessional team in evaluating, diagnosing, and managing the condition.

Objectives:

Describe the mechanism of injury that results in a boxer’s fracture of the hand.
Review the necessary elements for an examination to assess for boxer’s fracture, including any necessary diagnostic imaging studies.
Summarize the treatment options available for fractures of the neck of the fifth metacarpal, including both conservative and surgical care.
Explain the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients with fifth metacarpal neck fractures.

Access free multiple choice questions on this topic.

Introduction

Metacarpal fractures account for 40% of all hand fractures. [1] A Boxer’s fracture is a fracture of the fifth metacarpal neck, named for the classic mechanism of injury in which direct trauma is applied to a clenched fist. This represents 10% of all hand fractures. [1]Treatment for a Boxer’s fracture varies based on whether the fracture is open or closed, characteristics of the fracture including the degree of angulation, shortening, and rotation, and other concomitant injuries. Immobilization with an ulnar gutter splint may be the definitive treatment for closed, non-displaced fractures without angulation or rotation, while open fractures, significantly angulated or malrotated fractures or those involving injury to neurovascular structures may require operative fixation.

Etiology

The most common mechanism of injury for Boxer’s fracture is punching, e.g., the axial pressure applied to the metacarpal bone when the fist is in a clenched position. Direct trauma to the dorsum of the hand may also cause a fracture of the fifth metacarpal neck. Unlike many other hand and wrist fractures, a Boxer’s fracture typically does not occur with a fall onto an outstretched hand.

Epidemiology

The incidence of metacarpal neck fractures presenting for hospital care in the United States is 13.6 per 100,000 person-years.[1] Metacarpal fractures account for 40% of all hand fractures, [[1] while fractures of the fifth metacarpal neck account for 10% of all hand fractures. [1] The incidence in males is five times higher than in females.[2] Males aged ten to 19 have the highest incidence, followed by males aged 20 to 29[2].They commonly occur at home and at sporting/athletic events [2], [3].

Pathophysiology

The fifth metacarpal bone is one of the five metacarpal bones of the hand. The fifth metacarpal is associated with the fifth digit. The metacarpal bone consists of a head (distally located), neck, body, and base (proximally located). Axial load via direct trauma to a clenched fist transfers energy to the metacarpal bone, causing fractures most commonly at the neck, and typically resulting in apex dorsal angulation due in part to the forces exerted by the pull of the interosseous muscles. The interosseous muscles, responsible for adduction and abduction of the fingers, originate from the metacarpal shafts and insert onto proximal phalanges. The collateral ligaments also join the metacarpal bones to the proximal phalanges and must be taken into consideration during splinting to minimize the risk of loss of motion due to shortening of the ligaments. The ligaments are taut in flexion, and more slack in extension, therefore the MCP joints should be splinted in flexion to prevent shortening (intrinsic plus positioning)[4]. The arteries and nerves supplying the fingers are adjacent to the metacarpal bones and can be injured in severely displaced Boxer’s fractures, requiring surgical intervention.

History and Physical

Patients with Boxer’s fractures present with complaints of dorsal hand pain, swelling, and possible deformity in the setting of one of the mechanisms typically associated with this injury involving direct trauma to the hand.

Complete physical exam of a potential Boxer’s fracture should include an examination of the entire hand, comparison to the contralateral hand, with special attention to the following:

Skin: Closely inspect the skin for any breaks, especially near the metacarpal head, typically the point of impact. When a Boxer’s fracture is sustained by a blow to the face, the recipient’s tooth may cause a laceration or abrasion known as a “fight bite. ” This may require operative irrigation and debridement.
Neurovascular exam: As with all suspected fractures, a neurovascular exam should test for sensation, motor function, and blood flow distal to the injury.
Angulation: Boxer’s fractures are typically associated with apex dorsal angulation, thereby resulting in depression of the MCP joint and loss of the normal knuckle contour. With significantly angulated fractures, “pseudo-clawing” may be observed due to damage to the extensor apparatus; pseudo-clawing is a hyperextension of the MCP joint and flexion at the PIP joint. The degree of angulation is determined using plain films.
Rotational alignment: Any degree of malrotation warrants referral to a hand surgeon and therefore assessment of rotational alignment is a crucial component of the physical exam. Alignment can be assessed by examining the hand with the MCP and PCP joints in flexion, and DIP joints extended. If lines are drawn along the digits and extended distally, normally aligned digits will show the convergence of these lines. If the line extended from the fifth finger does not converge towards the others, suspect malrotation.
Malrotation can also be detected by examining the hand with the MCPs flexed, and PCPs and DIPs extended. The fingernails should be in line along a single plane.

Evaluation

Plain radiographs are the standard of care to diagnose Boxer’s fractures and determine a degree of angulation. Anteroposterior, lateral, and oblique views should be obtained. The lateral view should be used to measure the degree of angulation of the shaft of the metacarpal as compared to the mid-point of the fracture fragment.[5] Normal angulation of the metacarpal head to the neck is 15 degrees, so the angulation of the fracture should be measured as that more than the baseline of 15 degrees.

Recent literature suggests that bedside ultrasound may also be used to make an initial diagnosis of a Boxer’s fracture[6].

CT is generally not used for the diagnosis of metacarpal fractures; however occult fractures may be detected via CT in patients for whom there is a high degree of clinical suspicion for fracture and negative plain radiographs[7].

Treatment / Management

The appropriate treatment for a Boxer’s fracture on initial presentation varies based on whether the fracture is open or closed, the degree of angulation, rotation, and other concomitant injuries. Due to the risk of infection from “fight bite,” even very small wounds should be thoroughly irrigated, and there should be a low threshold for antibiotic treatment.

Immobilization Alone

For a Boxer’s fracture that is closed, not angulated, and not malrotated or otherwise displaced, splinting is used for initial immobilization. A Boxer’s fracture should be immobilized with an ulnar gutter splint. Alternatively, a pre-made Galveston splint or a custom orthosis may be used.

The hand should be positioned in the intrinsic plus position for splinting: mild wrist extension, 70 to 90 degrees of flexion at MCP joint, and slight flexion at the DIP and PIP joints. Flexion of these joints is important to prevent shortening of the collateral ligaments and subsequent loss of range of motion and functional impairment.

Closed Reduction

Closed reduction is required for a Boxer’s fracture with significant angulation greater than 30 degrees.

Analgesia options for the procedure include a hematoma block or an ulnar nerve block. Younger children or very anxious patients may require procedural sedation, but this procedure typically is tolerated well without sedation.

Closed reduction of a Boxer’s fracture is accomplished by using the “90-90 method.” The MCP, DIP, and PIP joints should all be flexed to 90 degrees. The clinician should then apply volar pressure over the dorsal aspect of the fracture site while applying pressure axially to the flexed PIP joint. This axial pressure to the PIP applies dorsal force to the distal fracture fragment. The clinician should be able to feel the reduction when it has been achieved. The injury should be immobilized with an ulnar gutter splint, and post-reduction films should be taken to assess for adequate reduction [8]. The fifth metacarpal neck can tolerate angulation of up to 50-60 degrees and management may be continued non-operatively if remains within the acceptable tolerances.

Surgical Referral

Surgical referral is indicated for fractures that are open, severely comminuted, associated with neurovascular injury, and for fractures with any malrotation[9]. Surgical referral is also appropriate for fractures with significant angulation if the initial provider is unsuccessful in achieving adequate reduction and alignment outside acceptable parameters. Surgical options include open reduction internal fixation, or closed reduction percutaneous pinning.

Follow-Up

Boxer’s fractures should be sent for repeat radiographs within one week to assess alignment. Radiographs should be obtained every two weeks following, until clinical and radiographic healing are present, typically between four to six weeks. Even with the adequate reduction, some cosmetic deformity may persist, with loss of the normal knuckle contour. After a short period of immobilization, the passive and active range of motion exercises should be performed to alleviate stiffness of the MCP and PIP joints. Literature supports early mobilization of these injuries rather than prolonged immobilization[10], [11]. If any loss of function persists after several weeks of these exercises, referral to occupational therapy is warranted.

Differential Diagnosis

Differential diagnosis for 5th metacarpal neck fractures include: fractures involving the metacarpal head, shaft, and base.

Prognosis

Literature has shown that closed management of fifth metacarpal neck fractures with less than 60-70 degrees of angulation have high functional capabilities as indicated by quickDASH scores at four months [12].

Complications

Complications of fifth metacarpal neck fractures include digit malrotation, nonunion, and loss of esthetic appears of the fifth knuckle [12]. These should be communicated with the patient when discussing operative and non-operative treatments.

Deterrence and Patient Education

If patients have minimal pain and no impairment of function, conservative treatment may be sufficient, even for angulated fractures. However, if there is any evidence of severe angulation, comminuted fractures, neurovascular injury, functional impairment, or unmanageable pain, patients should be referred to a hand surgeon. Thorough education with patients regarding management options should be discussed.

Enhancing Healthcare Team Outcomes

The delayed presentation is not uncommon with Boxer’s fracture, possibly due to some hesitation to present for care given the classic mechanism of the injury. Clinicians and nurses must be aware of and work together to identify patients with his injury. When patients present 2 to 3 weeks after sustaining this injury, as with initial presentation, assess function, angulation, and pain; these fractures typically heal without any functional detriment [Level V].

Review Questions

Access free multiple choice questions on this topic.
Comment on this article.

Figure

boxer fracture of left hand. Image courtesy S Bhimji MD

References

1.: de Jonge JJ, Kingma J, van der Lei B, Klasen HJ. Fractures of the metacarpals. A retrospective analysis of incidence and aetiology and a review of the English-language literature. Injury. 1994 Aug;25(6):365-9. [PubMed: 8045639]
2.: Nakashian MN, Pointer L, Owens BD, Wolf JM. Incidence of metacarpal fractures in the US population. Hand (N Y). 2012 Dec;7(4):426-30. [PMC free article: PMC3508027] [PubMed: 24294164]
3.: Cotterell IH, Richard MJ. Metacarpal and phalangeal fractures in athletes. Clin Sports Med. 2015 Jan;34(1):69-98. [PubMed: 25455397]
4.: Low CK, Wong HC, Low YP, Wong HP. A cadaver study of the effects of dorsal angulation and shortening of the metacarpal shaft on the extension and flexion force ratios of the index and little fingers. J Hand Surg Br. 1995 Oct;20(5):609-13. [PubMed: 8543865]
5.: Lamraski G, Monsaert A, De Maeseneer M, Haentjens P. Reliability and validity of plain radiographs to assess angulation of small finger metacarpal neck fractures: human cadaveric study. J Orthop Res. 2006 Jan;24(1):37-45. [PubMed: 16419967]
6.: Kocaoğlu S, Özhasenekler A, İçme F, Pamukçu Günaydın G, Şener A, Gökhan Ş. The role of ultrasonography in the diagnosis of metacarpal fractures. Am J Emerg Med. 2016 Sep;34(9):1868-71. [PubMed: 27396537]
7.: Hindman BW, Kulik WJ, Lee G, Avolio RE. Occult fractures of the carpals and metacarpals: demonstration by CT. AJR Am J Roentgenol. 1989 Sep;153(3):529-32. [PubMed: 2763950]
8.: Burkhalter WE. Closed treatment of hand fractures. J Hand Surg Am. 1989 Mar;14(2 Pt 2):390-3. [PubMed: 2659656]
9.: Jones NF, Jupiter JB, Lalonde DH. Common fractures and dislocations of the hand. Plast Reconstr Surg. 2012 Nov;130(5):722e-736e. [PubMed: 23096627]
10.: Meals C, Meals R. Hand fractures: a review of current treatment strategies. J Hand Surg Am. 2013 May;38(5):1021-31; quiz 1031. [PubMed: 23618458]
11.: Statius Muller MG, Poolman RW, van Hoogstraten MJ, Steller EP. Immediate mobilization gives good results in boxer’s fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Arch Orthop Trauma Surg. 2003 Dec;123(10):534-7. [PubMed: 14639483]
12.: van Aaken J, Fusetti C, Luchina S, Brunetti S, Beaulieu JY, Gayet-Ageron A, Hanna K, Shin AY, Hofmeister E. Fifth metacarpal neck fractures treated with soft wrap/buddy taping compared to reduction and casting: results of a prospective, multicenter, randomized trial. Arch Orthop Trauma Surg. 2016 Jan;136(1):135-42. [PubMed: 26559192]

: Disclosure: Saloni Malik declares no relevant financial relationships with ineligible companies.
: Disclosure: Tom Herron declares no relevant financial relationships with ineligible companies.
: Disclosure: Naomi Rosenberg declares no relevant financial relationships with ineligible companies.

The Boxer’s Fracture: Splint Immobilization Is Not Necessary

Review

. 2016 May 1;39(3):188-92.

doi: 10.3928/01477447-20160315-05.

Epub 2016 Mar 29.

John C Dunn, Nicholas Kusnezov, Justin D Orr, Mark Pallis, Justin S Mitchell

PMID:
27018606
DOI:
10.3928/01477447-20160315-05

Review

John C Dunn et al.

Orthopedics.

2016.

. 2016 May 1;39(3):188-92.

doi: 10.3928/01477447-20160315-05.

Epub 2016 Mar 29.

Authors

John C Dunn, Nicholas Kusnezov, Justin D Orr, Mark Pallis, Justin S Mitchell

PMID:
27018606
DOI:
10. 3928/01477447-20160315-05

Abstract

Fractures of the fifth metacarpal neck, or boxer’s fractures, are common, particularly among young men. Because of the high frequency of this injury, there is a considerable range of treatment options. The purpose of this systematic review was to determine whether reduction and splint or cast immobilization is necessary for fractures of the fifth metacarpal neck. The authors conducted a systematic review of all published studies that randomized these fractures to cast immobilization vs treatment with soft wrap without reduction. Cast immobilization is not superior to soft wrap without reduction in most cases. The study found that reduction and cast immobilization is not necessary for boxer’s fractures. [Orthopedics. 2016; 39(3):188-192.].

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Retrouvey H, et al.
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Beals C, et al.
Pediatr Qual Saf. 2019 Aug 30;4(5):e212. doi: 10.1097/pq9.0000000000000212. eCollection 2019 Sep-Oct.
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Are We Over Treating Hand Fractures? Current Practice of Single Metacarpal Fractures.
Retrouvey H, Morzycki A, Wang AMQ; Canadian Plastic Surgery Research Collaborative; Binhammer P.
Retrouvey H, et al.
Plast Surg (Oakv). 2018 Aug;26(3):148-153. doi: 10.1177/2292550318767926. Epub 2018 Apr 24.
Plast Surg (Oakv). 2018.
PMID: 30148125
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what is better to choose for a fracture? – health articles

Gypsum or orthosis to use for fractures? This question is of interest to many today. Unfortunately, it is impossible to give a definite answer to it. Let’s figure out why and find out what determines the choice in favor of a particular product.

Indications for the use of plaster

Plaster bandages are still widely used in traumatology. They are prescribed for adults and children. As an independent method of treatment, plaster bandages are indispensable for fresh fractures of the hands, forearms, feet, ankles, etc.

They are not used only for local infectious complications, which include gangrene, ischemic disorders of the limbs, purulent streaks, phlegmon and anaerobic infections.

It should be noted that today there are several varieties of gypsum. The traditional one is increasingly being replaced by a polymer one. Instead of a cotton bandage, a special mesh impregnated with polyurethane resin is used. Such gypsum can be made in the form of a bandage (activated by water) or blank sheets (activation occurs under the influence of temperature changes).

Polymer products:

allow for a breathable bandage that is highly breathable
stretch in various directions and allow you to get a retainer for any part of the body
features improved usability due to relatively light weight

You can take a bath with modern dressings. It is enough just to dry the product with a hairdryer after hygiene procedures. In addition, polymer gypsum is more elastic. It reduces the risk of muscular dystrophy. The polymer is X-ray permeable. This provides opportunities for diagnostics.

Of course, modern gypsum is not free. It is also important that its imposition is carried out using a special technology. Far from every medical institution, the staff owns it.

What plaster is better for a fracture? Of course, polymer. But it should be borne in mind that it is not always available in emergency rooms.

Indications for orthosis

Wearing such a product allows you to stimulate the fusion of bones and stabilize the joints, reducing the load on the damaged area. In addition, modern designs help strengthen ligaments, muscles and tendons. Additionally, they minimize pain and reduce the risk of edema.

Also indications for wearing it are:

post-traumatic conditions
arthritis and arthrosis of the joints
ligament problems: weakness, congenital instability, acquired injuries
malposition of the feet (when the child turns the feet inward, walks on toes, etc. )

Products are also recommended at the stage of recovery after surgical interventions.

What is better to choose in case of a fracture: plaster or orthosis

The exact answer to this question will be given only by a doctor. However, there are certain standards.

Instead of gypsum, an orthosis is not prescribed for complex closed and open fractures, in the presence of bleeding wounds, at the early stages of therapy. First, it is always better to apply the strongest possible bandage, which will ensure complete immobility of the damaged area. When the fusion process is started, you can remove it. Thus, orthoses are often used after a cast.

At the same time, the use of a modern design will allow you to carefully monitor the healing process. If necessary, the orthosis can be easily and quickly removed for x-ray or other diagnostics and a number of manipulations. The fixation of the structure can also be strengthened or weakened. This improves patient comfort.

The use of an orthosis on the ankle and other parts of the legs or arms instead of a cast makes it possible to:

for overall recovery time reduction
to reduce the number of complications after various injuries
to improve the general condition of the patient

Important! For fractures, both rigid and semi-rigid structures can be used. The choice in favor of a particular one is made exclusively by the doctor. You can choose a modern medical device exactly in size and taking into account all available indications. At the same time, it is very important that the orthosis is used by the patient correctly, in compliance with all recommendations. Only in this case, the rehabilitation process after a fracture will be as painless as possible and will require a minimum amount of time.

Benefits of contacting MEDSI

Quick rehabilitation with minimal discomfort. It is provided through the use of ankle and other orthoses instead of gypsum. Also, modern designs maintain normal tissue blood supply and are lightweight, resistant to moisture and easy to use
Experienced doctors. Our traumatologists-orthopedists always take into account the available indications and characteristics of the patient when choosing therapy. This allows you to achieve its pronounced effect
Comfort of visiting MEDSI. Our clinics are located near the metro. Registration for admission is carried out in advance. This avoids queues and long waiting times

To get help with fractures, use all the necessary services and ask questions about the conditions for their provision, call + 7 (495) 7-800-500. Our specialist will advise you and suggest the best time to visit the clinic. Recording is also possible through the SmartMed application.

Do not delay treatment, see a doctor right now:

Pediatric traumatologist appointment

Boxing splints

Boxing tires
made from elastic
plastics (Bock-force,
Elastoplast). They
designed to warn
dental injuries,
upper mucosa
lips and
temporomandibular joint
tawa at the boxers on time
fight. Shinapri
orthognathic bite
covers
entire upper jaw pretransitional
folds (teeth, alveolar
process, hard palate). For teeth
lower jaw on the free
tire top
there are prints.
reverse occlusion of the anterior teeth
tire covers
teeth
and alveolar
part of the bottom
jaws with
both sides and
its free surface has
teeth prints
top
jaws.

For the manufacture of
tires
remove full
anatomical
reprints al-
ginat
masses of super
lower jaws.
On plaster models
mark the border of the tire. From the side
it reaches the threshold
pretransitional
folds, bending the bridle
and strands of the mucous membrane and covering
maxillary tubercles. On the palatine
side of the tire captures the zone
transverse
folds, leaving free
palatine suture.

Rice.
242.
boxing
tires.

For compiling models in position
central occlusion
wax wax
roller height
2. 5mm
horseshoe shape. Spo-
the power of this heated roller in
oral cavity determine the central
occlusion.
establishment of central occlusion between the dental rows
The ladies must be shacking up
within 1.5 -1.8 mm. Models
gypsum occluder and
of waxed
tyre.Depth
prints
lateral teeth of the lower jaw
the tire should be approximately 1 mm, and in the area
anterior teeth
1.5 -2.0
mm (Fig. 242). Thickness
tires on all sections should be 1.8 -2.0
mm.Wax
tire composition
gypsum reverse
in a cuvette way.
Wax is replaced with plastic
accordance with techno-
applied
plastics.

I
FOREWORD –
prof.
E.I. Gavrilov 3

‘
INTRODUCTION –
prof.
E.I. Gavrilov 4

BRIEF
FEATURE ARTICLE
DEVELOPMENT

ORTHOPEDIC
DENTISTRY
–
prof.
E.I. Gavrilov 5

General course (propaedeutics)

ANATOMY
AND
PHYSIOLOGY

DENTAL
SYSTEMS
–
prof.
E.N.Zhulev 12
LOWER

JAW
13
UPPER

JAW
16
ALVEOLAR
TOP PARTS AND
LOWER
JAWS 19

temporomandibular

JOINT
20
TEETH
I
DENTAL

ROWS
22

Factors
providing stability
dental
rows 24

Occupational
surface
dental
rows 26

Building
and
functions
periodontal
27
Endurance
periodontal
k

load
31
MUSCLES

DENTAL
SYSTEMS
31

Mimic

muscles 31

Chewable

musculature
32
Absolute
strength
chewable
muscle
33
Chewable

pressure
34
OCCLUSION

I

ARTICULATION
36

Species

occlusion
36
Status
relative rest
bottom

jaws 38

Bite 39

Normal

(orthognathic)

bite
39
Transitional
(border)
molds

bite
41
ABNORMAL
BITES 41

Cystal

bite 42

metal

bite 42

Deep

bite
43
Open

bite 43

Crossed

bite
43
BIOMECHANICS

LOWER

JAWS
44

Vertical
movement
bottom

jaws
44
Sagittal
movement
bottom

jaws
45
Transversal
movement
bottom

jaws
46
CHEW 49

557

ANATOMICAL
FEATURES MUCOUS
ORAL SHELLS,

HAVING
VALUE
FOR

PROSTHETICS 51

SURVEY
SICK IN
CLINIC

ORTHOPEDIC
DENTISTRY
–
prof.
V.N.Trezubov 53

POLL

SICK

(ANAMNESIS)
54
OUTER

INSPECTION

SICK
56
EXAMINATION

CAVITIES

RTA
57

Examination

dental
rows 58

Examination

periodontal 59

Pathological

mobility

teeth 60

Examination
toothless
alveolar

parts 61

Diagnostic

models

jaws 62

X-ray
methods

research 63

Methods
definitions
chewable
pressure 64

Research
chewing efficiency
dental
rows 66

Graphic
methods

study
chewing movements
bottom

jaws 67

Examination

temporomandibular

joint 68

Examination
functions
chewable
muscles 70

Electromyography 70

Diagnosis
73
Plan
and tasks
orthopedic
treatment
73
History
diseases 74

PRELIMINARY
TREATMENT

BEFORE
PROSTHETIC – prof.

V.N.Trezubov
75

Wellness
activities in the cavity
mouth

before
prosthetics
patient 76

Tactics
doctor during tooth extraction from
sick
periodontal 77

Resection
(hemisection)
multi-root
teeth
79
Order
removal
teeth

at
oral preparation
to
prosthetics
79
About
removal of single standing
teeth

on
top and
bottom
jaws
80
Fix
alveolar shape
offshoot
(parts)
82
Psychological
preparation
patients

before

prosthetics
82

PRINTS
AND
IMPRESSION MATERIALS
–
prof.