Boxer’s Fracture

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.

Non-Surgical

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.

Surgical

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.


How can Dr. Knight help you with Boxer’s Fracture?

Dr. Knight welcomes you to any of our Dallas Fort-Worth accessible hand and wrist offices. Dr. Knight is an accomplished hand specialist. Come to our Southlake office or Dallas office today and bring life back to your hands.


Boxer’s Fracture Fact Sheet

What is a Boxer's fractre?Boxer's fractures are caused by trauma to the neck of the metacarpal, which causes the head of the bone to snap off at the knuckle. They gained their name because they are exceedingly common among professional boxers and other pugilists, and even non-professionals that present with these injuries often got them from punching something, whether a person or a wall or an upright post.
Can I deal with a Boxer's Fracture at home?Icing, immobilization, and painkillers are effective immediate treatments, but it is important to seek medical attention to ensure a successful treatment outcome.
What about medications? Are there any pills or potions that can effectively treat this type of fracture?Aside from painkillers to help with discomfort during the healing process, there are no medications indicated for the treatment of tha boxer's fracture.
Will a Boxer's Fracture be permanent or does treatment cur it?As with all fractures, the bones of the hands will eventually repair themselves, but withhout proper medical guidance, there is a likelihood of them not joining correctly and leaving you with a permanent malformation that may affect future mobility.
How does Dr. Knight address a Boxer's fracture?Boxer's fracture are usually easily treated non-surgically with a splint and time, but if the fracture is displaced then surgery may be necessary to repair it.

Frequently Asked Questions:

Can a Boxer’s Fracture heal on its own?
While certain fractures, such as hairline fractures, may be able to successfully knit together without much in the way of medical intervention, a Boxer’s fracture, due to the nature of the break and the position of the injury that typifies the condition, cannot simply be left to heal without any intervention. In layman’s terms, the head of the metacarpal, that is the bone that makes up the palm of the hand just below the finger, is effectively snapped off from the main shaft of the bone, which causes the sunken appearance of the knuckles that is a diagnostic symptom of the condition. Because the bone is broken in this way, the broken off part must be repositioned and reset within the hand itself, which requires splinting of the affected hand at the very least.

How long does a Boxer’s fracture take to heal?
Typically, the fracture associated with a Boxer’s fracture takes about six weeks to heal, and another six weeks to get back to the strength and range of motion that you had prior to the injury that led to the condition. Obviously, the age of the person suffering the condition and the severity of the initial injury can affect the healing time, as well as any interruptions to healing that might occur while the bones are mending.

Do I have to have surgery to repair a Boxer’s fracture?
Surgery is not required for the vast majority of people who suffer from a Boxer’s fracture. In most cases, aggressive splinting once the bone is reset will be more than enough to ensure a straight and precise healing of the bone that was broken. Surgery is only necessary if the break is so severe that the doctor has to go inside to reset the bone.

How can I tell if I have a Boxer’s fracture?
A Boxer’s fracture is actually one of the more readily recognizable conditions that can affect that hand, and it has a very distinct presentation that is unmistakable. Because the head of the metacarpal is broken off under the phalange, or the knuckle where the finger meets the hand, a person who is suffering from this condition will display a very specific and recognizable ‘sunken knuckle’ on whichever fingers are affected.


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HandAndWristInstitute.com does not offer medical advice. The information presented here is offered for informational purposes only. Read Disclaimer

Dr. John Knight
Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.