Boxer's fracture

An annotated boxer's fracture X-Ray

A boxer's fracture is the common name for a fracture at the neck of the bones which form the knuckles of the hand^[1]. The fracture usually occurs at the neck of the fifth metacarpal, which forms the knuckle of the little finger^[2], but the same name may also be used for a fracture at the neck of any of the metacarpals. This injury is also known as the brawler's fracture; a fracture of the neck of the fifth or fourth metacarpal can also be called a bar room fracture.^[3]

Causes

It is usually caused by the impact of a clenched fist with a skull or a hard, immovable object, such as a wall or a door. The knuckle of the index finger tends to lead the rest of the knuckles in a hard punch, and the knuckle compresses and snaps the neck of the metacarpal bone.

Treatment

These fractures are often angulated, and if severely so require pins to be put in place and realignment as well as the usual splinting. However, the prognosis on these fractures is generally good, with total healing time not exceeding 12 weeks. The first two weeks will show significantly reduced overall swelling with improvement in clenching ability showing up first. Ability to extend the fingers in all directions appears to improve more slowly. Hard casts are rarely required and soft casts or splints can be removed for brief periods of time to allow for activities such as showers and "airing out" the cast or splinted area so as to avoid skin rotting and permit cleansing of the cast or splinted area. Pain from this injury is generally very mild and rarely requires medications beyond over the counter drugs such as ibuprofen or acetaminophen. Muscle atrophy in isolated areas of 5 to 15 percent should be expected with a rehabilitation period of approximately 4 months given adequate therapy. In the mildest of cases, full rehabilitation status can be achieved within 3 to 4 months.

For smaller angled fractures most discomfort is alleviated by raising the fracture above the heart, also if there is no cast warm water will relieve some of the pain. It is important that when the cast is removed that the hand is gently exercised by attempting the common functions of the hand.

Prevention

Boxers and other combat athletes routinely use hand wraps and boxing gloves to help stabilize the hand, greatly reducing pain and risk of injury during impact training such as working the heavy bag. Hand wraps are made with typical athletic tape. Karate and Tae kwon-do practitioners avoid this injury by striking with straight punches using the knuckles of the index and middle fingers. It has been concluded through martial arts training that punching with the tightest possible clenched fist can prevent this type of fracture as well.^{[citation needed]}

References

External links

• http://www.med.umich.edu/1libr/sma/sma_meta5car_art.htm
• http://www.wheelessonline.com/ortho/boxers_fracture_metacarpal_neck_1