Boxer’s Fracture

(Fifth Metacarpal Fracture)
  • Definition

    Boxer's fracture is a common name for a fracture of the long bone that connects the little finger to the wrist.
    The types of boxer's fractures are:
    • Nondisplaced—the bone is broken, but remains in place
    • Displaced—ends of the bone are separated from one another
    • Comminuted—the bone is broken into several pieces
    Fractures may either be:
    • Closed—the fracture does not break the skin
    • Open—the fracture breaks through the skin
    Bones in the Hand
    Bones in the Hand
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  • Causes

    Boxer's fracture can be caused by:
    • Punching another person or object, such as a wall, with a closed fist
    • Falls
    • Playing certain sports
    • Squeezing or crushing of the hand
  • Risk Factors

    Boxer's fractures are more common in men. Other factors that increase your chance of a boxer's fracture include:
    • Prone to angry outbursts or fighting
    • Participating in certain sports, such as boxing or football
    • Advancing age
    • Osteoporosis
    • Certain diseases or conditions that result in bone or mineral loss, such as abnormal or absent menstrual cycles, or post- menopause
    • Certain diseases and conditions that weaken bones, such as tumors or cysts
    • Decreased muscle mass
    • Exposure to, or prone to violence
  • Symptoms

    A boxer's fracture may cause:
    • Swelling
    • Pain
    • Deformity
    • Lack of movement
    • Depressed knuckle
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will also be done. The injured finger will be examined. Tests may include:
    • Range-of-motion tests
    • X-rays
  • Treatment

    Proper treatment can prevent long-term complications or problems with your finger or hand. Treatment will depend on how serious the fracture is, but may include:
    Intial Care
    Extra support may be needed to protect, support, and keep your finger in line while it heals. Supportive steps may include a splint, brace, or cast.
    Some fractures cause pieces of bone to separate. Your doctor will need to put these pieces back into their proper place. This may be done:
    • Without surgery—you will have anesthesia to decrease pain while the doctor moves the pieces back into place
    • With surgery—pins, screws, or plates may be needed to reconnect the pieces and hold them in place
    Wound care is an important part of your recovery. This is especially true if you punched a wall, or someone in the mouth, which resulted in a break in the skin.
    Children’s bones are still growing at an area of the bone called the growth plate. If the fracture affected the growth plate, your child may need to see a specialist. Injuries to the growth plate will need to be monitored to make sure the bone can continue to grow as expected.
    Medications
    Your doctor may recommend:
    • Over-the-counter pain relievers, such as acetaminophen or non-steroidal anti-inflammatory medication (NSAIDs)
    • Prescription pain relievers
    • Antibiotics if an infection is present or possible
    Check with your doctor before taking nonsteroidal anti-inflammatory medications, such as ibuprofen or aspirin.
    Note: Aspirin is not recommended for children with a current or recent viral infection. Check with your doctor before giving your child aspirin.
    Depending on your vaccination history, you may need a tetanus or other shots.
    Rest and Recovery
    Healing time varies by age and your overall health. Children and people in better overall health heal faster. In general, it takes up to 6 weeks for a boxer's fracture to heal.
    You will need to adjust your activities while your finger heals, but complete rest is rarely required. Ice and elevating the hand at rest may also be recommended to help with discomfort and swelling.
    As you recover, you may be referred to physical therapy or rehabilitation to start range-of-motion and strengthening exercises. Do not return to activities or sports until your doctor gives you permission to do so.
    If you have a boxer's fracture, follow your doctor's instructions .
  • Prevention

    To help reduce your chance of boxer's fracture, take these steps:
    • Do not put yourself at risk for trauma to the bone.
    • Avoid situations where fights may occur.
    • Consider anger management if you have repeated anger outbursts or are prone to fighting.
    • Wear proper padding and safety equipment when participating in sports or activities.
    To help reduce falling hazards at work and home, take these steps:
    • Clean spills and slippery areas right away
    • Remove tripping hazards such as loose cords, rugs, and clutter
    • Use non-slip mats in the bathtub and shower
    • Install grab bars next to the toilet and in the shower or tub
    • Put in handrails on both sides of stairways
    • Walk only in well-lit rooms, stairs, and halls
    • Keep flashlights on hand in case of a power outage
  • RESOURCES

    American Academy of Orthopaedic Surgeons http://www.orthoinfo.org

    American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org

    Canadian Orthopaedic Foundation http://www.canorth.org

    References

    Gudmundsen TE, Borgen L. Fractures of the fifth metacarpal. Acta Radiol. 2009;50(3):296-300.

    Hand and wrist pain—differential diagnosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us . Accessed September 17, 2013.

    Hand fractures. American Academy of Orthopedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00010 . Updated October 2007. Accessed September 17, 2013.

    Poolman RW, Goslings JC, et al. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database Syst Rev. 2005;(3):CD003210.

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