• 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.
    The types of boxer's fractures are:
    • Nondisplaced—the bone is broken, but remains in place
    • Displaced—ends of the bone are separated from one another
    • Comminuted—the bone is broken into several pieces
    Fractures may either be:
    • Closed—the fracture does not break the skin
    • Open—the fracture breaks through the skin
    Bones in the Hand
    Bones in the Hand
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    Causes

    Boxer's fracture can be caused by:
    • Punching another person or object, such as a wall, with a closed fist
    • Falls
    • Playing certain sports
    • Squeezing or crushing of the hand

    Risk Factors

    Boxer's fractures are more common in men. Other factors that may increase your risk of a boxer's fracture include:
    • Being prone to angry outbursts or fighting
    • Participating in certain sports, such as boxing or football
    • Increased age
    • Osteoporosis
    • Certain diseases or conditions that result in bone or mineral loss, such as abnormal or absent menstrual cycles, or post- menopause
    • Certain diseases and conditions that weaken bones, such as tumors or cysts
    • Decreased muscle mass
    • Exposure to violence

    Symptoms

    A boxer's fracture may cause:
    • Swelling
    • Pain
    • Deformity
    • Lack of movement
    • Depressed knuckle

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. The injured finger will be examined.
    Images may be taken of your hand. This can be done with x-rays.

    Treatment

    Proper treatment can prevent long-term complications or problems with the finger or hand. Treatment will depend on how serious the fracture is, but may include:

    Initial Care

    Extra support may be needed to protect, support, and keep the finger in proper position while it heals. Supportive steps may include a splint, brace, or cast.
    Some fractures cause pieces of bone to separate. These pieces will need to be put back into their proper place. This may be done:
    • Without surgery—anesthesia will be needed to decrease pain while the pieces are moved back into place
    • With surgery—pins, screws, or plates may be needed to reconnect the pieces and hold them in place
    Wound care is an important part of recovery. This is especially true if there was a break in the skin.
    Children’s bones are still growing at an area of the bone called the growth plate. If the fracture affected the growth plate, a specialist may be needed. Injuries to the growth plate will need to be monitored to make sure the bone can continue to grow as expected.

    Medications

    Over-the-counter or prescription pain medication may be given to reduce discomfort. Antibiotics may also be given if an infection is present or possible.
    Depending on your vaccination history, you may need a tetanus or other shots.

    Rest and Recovery

    Healing time varies by age and overall health. Children and people in better overall health heal faster. In general, it takes up to 6 weeks for a boxer's fracture to heal.
    Activities will need to be adjusted while the finger heals, but complete rest is rarely needed. Ice and elevating the hand at rest may also be advised to help with discomfort and swelling.
    A physical therapist or rehabilitation program may be advised to start range-of-motion and strengthening exercises.

    Prevention

    To help reduce your chance of boxer's fracture:
    • Do not put yourself at risk for trauma.
    • Avoid situations where fights may occur.
    • Consider anger management if you have repeated anger outbursts or are prone to fighting.
    • Wear proper padding and safety equipment when participating in sports or activities.
    To help reduce falling hazards at work and home:
    • Clean spills and slippery areas right away.
    • Remove tripping hazards such as loose cords, rugs, and clutter.
    • Use non-slip mats in the bathtub and shower.
    • Install grab bars next to the toilet and in the shower or tub.
    • Put in handrails on both sides of stairways.
    • Walk only in well-lit rooms, stairs, and halls.
    • Keep flashlights on hand in case of a power outage.

    RESOURCES

    American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

    Ortho Info—American Academy of Orthopaedic Surgeons http://www.orthoinfo.org

    CANADIAN RESOURCES

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

    When it Hurts to Move—Canadian Orthopaedic Foundation http://whenithurtstomove.org

    References

    Gudmundsen TE, Borgen L. Fractures of the fifth metacarpal. Acta Radiol. 2009;50(3):296-300.

    Metacarpal neck fracture—emergency management. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T903303/Metacarpal-neck-fracture-emergency-management. Accessed August 24, 2017.

    Hand fractures. American Academy of Orthopedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00010. Updated October 2007. Accessed August 24, 2017.

    Poolman RW, Goslings JC, et al. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database Syst Rev. 2005;(3):CD003210.

    Revision Information

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