What is a Boxer’s Fracture?
The bones of the hand consist of the carpal, or wrist bones; the metacarpal bones, which lie between the wrist bones and the finger bones; and the phalangeal bones, which form the fingers. A boxer’s fracture is a fracture of the neck of the metacarpal bone at the end closest to the knuckle. Although this type of fracture is most common near the knuckle of the fifth, or “pinky” finger, it can occur near the knuckle of the ring, middle or index fingers as well.
What Causes a Boxer’s Fracture?
A boxer’s fracture is caused by forcefully striking an object while the hand is clenched into a fist. This usually occurs in a fistfight or when a person punches a wall in anger. Occasionally, a fall onto an outstretched arm with the hand clenched into a fist can cause this type of fracture. If a clenched fist is hit by an object, like a baseball bat, it may also result in this type of injury.
What are the symptoms of a Boxer’s Fracture?
Pain, swelling, and bruising around the affected knuckle are experienced with a Boxer’s fracture. Range of motion in the associated finger may be decreased. There may be snapping or popping felt when a fist is made. The affected finger may rotate toward the thumb when a fist is made signifying displacement. The skin overlying the affected area may be broken in multiple ways. A bone fragment could puncture the skin from within. A laceration from the outside could result from striking an opponent in the mouth, or from punching though a window, door, or wall.
How is a Boxer’s Fracture diagnosed?
A careful history and thorough physical exam will usually indicate that a Boxer’s fracture is present. Imaging studies are used to confirm the diagnosis and to help plan a course of treatment. X rays are performed in several views to properly assess the fracture. X rays can show glass shards, metal splinters, or gravel which may be present in the wound. X rays do have their limitations. Sometimes an occult fracture is present and will not show up on X rays. X rays also will not show some types of foreign bodies which may be present, such as wood splinters. Xrays are also limited in their ability to demonstrate injury to nerves, tendons, and blood vessels. If these types of injuries are suspected, CT or MRI may be needed to fully elucidate the nature of the injury.
How is a Boxer’s Fracture treated?
Boxer’s Fractures can be treated non surgically or surgically depending on the severity of the fracture.
The vast majority of Boxer’s Fractures will not need surgical intervention. If the fracture is displaced, closed reduction can frequently be performed in the emergency department and a splint can be placed to immobilize the hand. The patient can then follow up with the Hand Surgeon as an outpatient. Splints are typically worn for six weeks, and removal may be followed by Physical Therapy.
Indications for surgical treatment include the need for surgical debridement of an open wound, damage to a ligament, tendon, blood vessel, or nerve, and large degrees of joint displacement. If the metacarpal bone associated with the second or third finger is displaced, surgery will be needed to correct the injury. A moderate degree of displacement is acceptable in the fourth or fifth metacarpal, and a splint will usually suffice.
Surgical repair of a Boxer’s fracture is usually done through open reduction and internal fixation. In this type of procedure, an incision is made in the skin overlying the fracture, and rods, pins, or screws are implanted in the bones to keep them in place. The wound is closed and a splint is placed. Once the splint is removed, Physical Therapy is prescribed to strengthen the surrounding muscles and return the hand to full function.
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