Boxer’s fracture cast or splint. Boxer’s Fracture: Comprehensive Guide to Treatment and Management

22.02.202120.07.2023 by alexxlab

How is a boxer’s fracture treated? What are the important considerations in managing this type of hand injury? Get the answers to these questions and more in this detailed guide.

Содержание

Understanding Boxer’s Fracture

Boxer’s fracture, also known as a fracture of the fifth metacarpal neck, is one of the most common hand fractures, accounting for 10% of all hand fractures. This injury typically occurs when direct trauma is applied to a clenched fist, such as when punching an object. Unlike other hand and wrist fractures, a boxer’s fracture usually does not result from a fall onto an outstretched hand.

Epidemiology and Risk Factors

The incidence of metacarpal neck fractures presenting for hospital care in the United States is 13.6 per 100,000 person-years. Metacarpal fractures account for 40% of all hand fractures, with the fifth metacarpal neck fracture being the most common subtype. The incidence in males is five times higher than in females, with the highest rates seen in males aged 10 to 19 and 20 to 29. These injuries commonly occur at home and during sporting or athletic events.

Pathophysiology and Anatomy

The fifth metacarpal bone is one of the five metacarpal bones in the hand. Axial load from direct trauma to a clenched fist transfers energy to the metacarpal bone, most commonly causing a fracture at the neck. This typically results in apex dorsal angulation due to the pull of the interosseous muscles, which originate from the metacarpal shafts and insert onto the proximal phalanges. The collateral ligaments that join the metacarpal bones to the proximal phalanges must also be considered during splinting to minimize the risk of loss of motion due to shortening.

Clinical Presentation and Evaluation

Patients with boxer’s fractures typically present with complaints of dorsal hand pain, swelling, and possible deformity. A complete physical exam should include an assessment of the range of motion, neurovascular status, and any associated injuries. Imaging studies, such as radiographs, may be necessary to confirm the diagnosis and evaluate the extent of the fracture.

Treatment Options

The treatment for a boxer’s fracture depends on various factors, including whether the fracture is open or closed, the degree of angulation, rotation, and the presence of any concomitant injuries. Conservative management with an ulnar gutter splint may be appropriate for closed, non-displaced fractures without significant angulation or rotation. However, open fractures, severely angulated or malrotated fractures, or those involving neurovascular structures may require surgical intervention by a hand surgeon.

Interprofessional Team Approach

Effective management of boxer’s fractures requires a coordinated effort from an interprofessional team, including emergency physicians, orthopedic surgeons, physical therapists, and nursing staff. This team approach helps ensure a comprehensive evaluation, appropriate treatment, and optimal outcomes for patients with this common hand injury.

Frequently Asked Questions

What is the most common mechanism of injury for a boxer’s fracture?
The most common mechanism of injury for a boxer’s fracture is punching, where the axial pressure is applied to the metacarpal bone when the fist is in a clenched position.

How are boxer’s fractures treated?
Treatment for a boxer’s fracture depends on the characteristics of the fracture, such as whether it is open or closed, the degree of angulation, and the presence of any other injuries. Conservative management with an ulnar gutter splint may be appropriate for closed, non-displaced fractures, while open fractures or those with significant angulation or malrotation may require surgical intervention.

Why is it important to involve an interprofessional team in managing boxer’s fractures?
An interprofessional team approach, including emergency physicians, orthopedic surgeons, physical therapists, and nursing staff, helps ensure a comprehensive evaluation, appropriate treatment, and optimal outcomes for patients with boxer’s fractures. This coordination of care is crucial for managing this common hand injury.

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

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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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Prospective Multicenter Randomized Controlled Trial Comparing Early Protected Movement and Splinting for Fifth Metacarpal Neck Fracture.
Retrouvey H, Jakubowski J, Al-Taha M, Steve A, Augustine H, Stein MJ, Al-Halabi B, Efanov JI, Morzycki A, Tang D, LeBlanc M, Binhammer P; Canadian Plastic Surgery Research Collaborative.
Retrouvey H, et al.
Plast Surg (Oakv). 2022 Feb;30(1):6-15. doi: 10.1177/22925503211011952. Epub 2021 May 17.
Plast Surg (Oakv). 2022.
PMID: 35096686
Free PMC article.
Clinical Outcomes of Severely Angulated Fifth Metacarpal Neck Fractures Treated Nonsurgically.
France TJ, Leversedge FJ, Lauder A.
France TJ, et al.
Hand (N Y). 2023 Jun;18(4):604-611. doi: 10.1177/15589447211063238. Epub 2022 Jan 7.
Hand (N Y). 2023.
PMID: 34991365
Analysis of the Quality of Prospective Randomized Controlled Trials for Treatment of Boxer’s Fractures.
Patrick CM, Fernandez I, Gonzalez GA, Nesti LJ, Dunn JC.
Patrick CM, et al.
Hand (N Y). 2023 Mar;18(2):294-299. doi: 10.1177/15589447211024379. Epub 2021 Jun 21.
Hand (N Y). 2023.
PMID: 34148387
Clinical Trial.
Reducing Healthcare Costs in the Management of Pediatric Metacarpal Neck Fractures.
Beals C, Lin J, Holstine JB, Samora JB.
Beals C, et al.
Pediatr Qual Saf. 2019 Aug 30;4(5):e212. doi: 10.1097/pq9.0000000000000212. eCollection 2019 Sep-Oct.
Pediatr Qual Saf. 2019.
PMID: 31745515
Free PMC article.
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
Free PMC article.

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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 according to I.

I. Revzin — Сirca.su

!– Yandex.RTB –>

Boxing tires according to I. I. Revzin

Boxing splints made of elastic plastic EGmass-12 are used to prevent damage to the teeth and jaws of boxers during the round.

A boxing splint for people with an orthognathic bite is prepared for the upper jaw. At the same time, it should cover all the teeth of the upper jaw and the mucous membrane of the alveolar process from the vestibule of the mouth and hard palate. On its free surface, it is necessary to create prints of the chewing and cutting surfaces of the dentition of the lower jaw. With a progenic type of bite, it is prepared for the lower jaw. At the same time, it covers all the teeth and the alveolar process and has imprints of the teeth of the upper dentition on the free surface.

Impressions are taken from both jaws to make a splint. The latter are best removed with an alginate mass. According to the obtained models, the borders of the tire are marked with a pencil. From the side of the vestibule of the mouth, it reaches the transitional fold, bypassing the labial frenulum, buccal folds and covering the alveolar tubercles. The palatine torus is not covered. For better fixation of the tire on the palatal surface of the chewing teeth and the labial surface of the frontal teeth, from the equator to their necks, a layer of gypsum 0.5 mm thick is scraped off. According to the outlined boundaries, the tire is modeled using a heated plate of modeling wax, which is applied to the model and pressed with fingers within the intended boundaries. On the wax base of the splint, a wax roller 2.5 mm high is applied in the area of the occlusal surfaces of the teeth along the entire dental arch of the upper jaw and connected to the wax base with melted wax. Then the wax base with the bite roller is removed from the model and the position of the central occlusion is determined in the clinic. At the same time, it is necessary to maintain the separation between the dentition within 1. 5-1.8 mm. The depth of imprints of molars on the wax roller should be approximately 1 mm, and in the area of the frontal teeth, 1.5 mm.

Plastering is done in the reverse way. After the gypsum has hardened, the cuvette is immersed in hot water to soften the wax, after which the cuvette is opened, the wax is melted, the plaster mold is degreased, and plastic molding is started according to the following recipe: 12–15 ml of dibutyl phthalate are added to 20–25 g of colored PVC powder. This mixture is kept for at least 30 minutes in order to swell the powder in the plasticizer, after which the cuvette is molded and pressed. After pressing, the cuvette, fixed in the byugel, is placed in a vulcanizer filled with water. The vulcanizer is heated slowly over 30-45 minutes to 160°. 5 minutes after reaching this temperature, the heat supply is stopped, and after complete cooling of the cuvette, the tire is removed. Excess plastic is cut off with scissors, the tire is treated with carborundum stones, it is not polished.