BOXER'S FRACTURE                                                        KANDIL NOTES

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

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