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Boxer's Fracture

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What is a boxer's fracture?
A boxer's fracture usually occurs when striking a firm object, such as a person's skull or a wall with a clenched fist (Figure 1).

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The boxer's fracture is a broken bone of the hand, normally at the base of the small finger or the neck of the fifth metacarpal (Figure 2). The end of the 5th metacarpal takes the force of the impact and breaks at its neck and angulates towards the palm creating a dorsal bump (Figure 3). The head of the metacarpal bones form the knuckle of a closed fist.

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Patients who sustain a boxer's fracture commonly complain of pain, swelling and deformity at the base of the small finger (Figure 4). X-rays are needed to diagnose the fracture and the angulation of the fracture (Figure 5).

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The 2nd and 3rd CMC are not mobile, a deformity in this area is usually is not acceptable. Compensatory movement takes place at the mobile CMC joint of the fourth and the fifth fingers. Less than 40° of the deformity is acceptable. A surgeon is less likely to correct the deformity, to obtain anatomic reduction, in the 4th and 5th metacarpals. Any deformity more than 40° requires possible intervention to avoid pseudoclawing. In Boxer's Fracture, the patient may end by a bump at the knuckle that usually does not affect the hand function.

Treatment
Treatment for a boxer's fracture is usually a splint. It is used to allow the fracture to heal especially if the deformity is not severe. The fracture may need closed reduction and splinting to improve the deformity and to immobilize the fracture. The splint should be applied in the position of hand function (extension of the wrist and flexion of the MCP joint). Surgery is rare for this type of fracture, but the surgery is usually successful.

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