A boxer’s fracture often occurs when a person hits a hard object or another person. Some of these hand injuries require 4-6 weeks in a cast. Occasionally this hand fracture requires surgery. In this post, I share information on the injury, its diagnosis and treatment.

What is a boxer’s fracture?

A boxer’s fracture is a break in the fourth or fifth metacarpal. The metacarpals are the long bones in the hand below the fingers. A boxer’s fracture specifically describes a fracture of the metacarpal below the ring or little finger. The fracture occurs at the metacarpal neck, or the part of the bone just below the knuckle at the base of the finger.

Mechanism of injury

You can suffer this type of hand fracture by hitting a hard object. Often the person punches another person or a wall. Alternatively he might be hit directly on this portion of his hand by a hard object such as a flying ball or bat in baseball.

Throwing a punch could cause a boxer’s fracture

Symptoms of the hand injury

If you suffer this injury, you will notice pain at a specific location along your fourth or fifth metacarpal just below the knuckle at the base of the finger. You will probably have swelling or bruising of that portion of the hand. An obvious deformity could indicate displacement or angulation of the bone. A skin wound over this area could represent an open fracture.

Diagnosis of this hand fracture

An orthopedic surgeon or hand surgeon suspects a boxer’s fracture based on the presence of bony deformity in this location at the fourth or fifth metacarpal neck. Tenderness directly at that site can suggest the injury as well. He will also look for any signs of an open fracture. X-rays of the hand will show the fracture and any amount of displacement or angulation.

While this x-ray is negative, the arrow points to where a boxer’s fracture would be.
While this x-ray is negative, the arrow points to where a boxer’s fracture would be located.

Treatment of a boxer’s fracture

If the fracture lines up anatomically, the surgeon will likely treat you without surgery. The surgeon usually places the patient’s hand in a cast or splint. The cast holds the fracture in place until it heals. X-rays taken at regular intervals can determine whether the fracture is healing in the appropriate position.

Also read:
When should you see a doctor for a boxer’s fracture?

Surgical treatment

If your fracture is angulated or displaced, you could require surgery. Often the angulation is significant enough that hand function could suffer if the fracture heals in that position. Surgery to reduce the fracture into better alignment and hold it in place with pins or wires can be necessary. An open fracture requires debridement and irrigation of the wound to decrease the risk of infection.

Since there is a possibility of surgery for a boxer’s fracture, consider seeing a hand surgeon soon if you feel you might have suffered such an injury.

Also read:
Ask Dr. Geier – Risk of a scaphoid fracture not healing

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