INTRODUCTION​

• A boxer’s fracture is an injury to the hand where the fifth metacarpal bone is fractured at the neck of the bone

• The location is below the level of the small finger knuckle

• Significantly more common in males

• An open boxer’s fracture resulting from a human fight is a presumed open injury to the MCP joint

• 40% of all hand injuries are metacarpal fractures

CAUSES

• The majority of boxer’s fractures occur when a patient punches a person or object

SIGNS AND SYMPTOMS

• Pain below the level of the small finger knuckle

• Swelling and bruising near the small finger knuckle

• Pain with forming a fist

TREATMENT​​

• Treatment of boxer’s fractures depends on angulation and shortening

• Acceptable angulation and shortening of the fifth metacarpal neck are the following

• Acceptable shaft shortening: 2-5mm

• Acceptable neck angulation: 50-60 degrees

• If boxer’s fracture is within acceptable parameters, treatment is immobilization in an ulnar gutter cast in intrinsic plus position. A reduction maneuver can be attempted before reduction if initial x-rays show unacceptable angulation and shortening

• If fracture parameters are unacceptable and/or there is malrotation, surgical treatment is recommended. Surgical options include closed reduction and pinning or open reduction internal fixation

        PREVENTION

• Don’t punch things