Boxer's Fracture

ExitCare ImageBoxer's fracture is a broken bone (fracture) of the fourth or fifth metacarpal (ring or pinky finger). The metacarpal bones connect the wrist to the fingers and make up the arch of the hand. Boxer's fracture occurs toward the body (proximal) from the first knuckle. This injury is known as a boxer's fracture, because it often occurs from hitting an object with a closed fist.

SYMPTOMS

  • Severe pain at the time of injury.

  • Pain and swelling around the first knuckle on the fourth or fifth finger.

  • Bruising (contusion) in the area within 48 hours of injury.

  • Visible deformity, such as a pushed down knuckle. This can occur if the fracture is complete, and the bone fragments separate enough to distort normal body shape.

  • Numbness or paralysis from swelling in the hand, causing pressure on the blood vessels or nerves (uncommon).

CAUSES

  • Direct injury (trauma), such as a striking blow with the fist.

  • Indirect stress to the hand, such as twisting or violent muscle contraction (uncommon).

RISK INCREASES WITH:

  • Punching an object with an unprotected knuckle.

  • Contact sports (football, rugby).

  • Sports that require hitting (boxing, martial arts).

  • History of bone or joint disease (osteoporosis).

PREVENTION

  • Maintain physical fitness:

  • Muscle strength and flexibility.

  • Endurance.

  • Cardiovascular fitness.

  • For participation in contact sports, wear proper protective equipment for the hand and make sure it fits properly.

  • Learn and use proper technique when hitting or punching.

PROGNOSIS

When proper treatment is given, to ensure normal alignment of the bones, healing can usually be expected in 4 to 6 weeks. Occasionally, surgery is necessary.

RELATED COMPLICATIONS

  • Bone does not heal back together (nonunion).

  • Bone heals together in an improper position (malunion), causing twisting of the finger when making a fist.

  • Chronic pain, stiffness, or swelling of the hand.

  • Excessive bleeding in the hand, causing pressure and injury to nerves and blood vessels (rare).

  • Stopping of normal hand growth in children.

  • Infection of the wound, if skin is broken over the fracture (open fracture), or at the incision site if surgery is performed.

  • Shortening of injured bones.

  • Bony bump (prominence) in the palm or loss of shape of the knuckles.

  • Pain and weakness when gripping.

  • Arthritis of the affected joint, if the fracture goes into the joint, after repeated injury, or after delayed treatment.

  • Scarring around the knuckle, and limited motion.

TREATMENT

Treatment varies, depending on the injury. The place in the hand where the injury occurs has a great deal of motion, which allows the hand to move properly. If the fracture is not aligned properly, this function may be decreased. If the bone ends are in proper alignment, treatment first involves ice and elevation of the injured hand, at or above heart level, to reduce inflammation. Pain medicines help to relieve pain. Treatment also involves restraint by splinting, bandaging, casting, or bracing for 4 or more weeks.

If the fracture is out of alignment (displaced), or it involves the joint, surgery is usually recommended. Surgery typically involves cutting through the skin to place removable pins, screws, and sometimes plates over the fracture. After surgery, the bone and joint are restrained for 4 or more weeks. After restraint (with or without surgery), stretching and strengthening exercises are needed to regain proper strength and function of the joint. Exercises may be done at home or with the assistance of a therapist. Depending on the sport and position played, a brace or splint may be recommended when first returning to sports.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be necessary. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Pain, tenderness, or swelling gets worse, despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • You develop signs of infection, after surgery (fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the surgical area).

  • You feel you have reinjured the hand.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)