• Boxer’s Fracture

    (Fifth Metacarpal Fracture)

    Definition

    Boxer's fracture is a common name for a fracture of the long bone that connects the little finger to the wrist. This type of fracture may create several fragments. This is called a comminuted fracture. It may also be displaced. This means that the two ends of the bone are separated. In addition, the fracture may be:
    • Closed—skin is not broken
    • Open—skin is broken (often because it strikes a sharp object)
    Bones in the Hand
    Bones in the Hand
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    Causes

    The most common cause is punching a hard object while boxing or fighting.

    Risk Factors

    These factors increase your chance of developing boxer’s fracture. Tell your doctor if you have any of these risk factors:
    • Participating in contact sports (eg, boxing, martial arts)
    • Advanced age
    • Postmenopausal
    • Osteoporosis
    • Are exposed to violence

    Symptoms

    If you have any of these symptoms, do not assume it is due to boxer’s fracture. These symptoms may be caused by other conditions. Tell your doctor if you have any of these symptoms in your little finger:
    • Swelling
    • Pain
    • Deformity
    • Lack of movement
    • Depressed knuckle (a permanent bump may occur even after treatment)

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will also be done. The injured finger will be examined. Tests may include:
    • Range-of-motion tests
    • X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones

    Treatment

    Treatment is usually effective. You may have stiffness and a permanent bump on the hand. Talk with your doctor about the best treatment for you. Options include:

    Home Care

    • Rest—A cast will likely be applied to give your finger time to heal. You will need to limit use of your hand.
    • Ice—Apply ice or a cold pack to the finger for 15-20 minutes, four times a day. Do this for several days after the injury. Wrap the ice in a towel. Do not apply it directly to your skin. This will relieve swelling. If you have a cast, check with the doctor to see if he wants you to apply ice.
    • Elevation—To relieve swelling and pain, prop your hand on a pillow when you are sitting or lying down.

    Surgery or Procedures

    If the bones are not aligned correctly, they may have to be moved for proper healing. Once the bones are in place, you will have to wear a splint or cast for about six weeks.

    Medications

    Your doctor may recommend:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen )
    • Pain reliever (eg, acetaminophen )
    • Antibiotics to prevent infection (if you had an open fracture)

    Rehabilitation

    Your doctor may recommend range-of-motion and strengthening exercises once the fracture has healed. You may be referred to a physical therapist.

    Prevention

    To help reduce your chances of getting boxer’s fracture, take the following steps:
    • Avoid situations where fights may occur.
    • Exercise regularly to build strong bones and muscles.

    RESOURCES

    American Academy of Family Physicians http://www.aafp.org/

    American Academy of Orthopedic Surgeons http://orthoinfo.aaos.org/

    CANADIAN RESOURCES

    Canadian Family Physician http://www.cfp.ca/

    Canadian Orthopaedic Association http://www.coa-aco.org/

    References

    Acute finger injuries: part II: fractures, dislocations, and thumb injuries. American Family Physician website. Available at: http://www.aafp.org/afp/2006/0301/p827.html . Published March 1, 2006. Accessed February 4, 2010.

    Hand fractures. American Academy of Orthopedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00010 . Updated October 2007. Accessed February 4, 2010.

    Howson A. Discharge instructions for boxer’s fracture. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=1034 . Updated November 1, 2009. Accessed February 4, 2010.

    Poolman RW, Goslings JC, Lee J, Statius M, Steller, E. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Collaboration website. Available at: http://www.cochrane.org/reviews/en/ab003210.html . Updated August 4, 2008. Accessed February 4, 2010.

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