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Boxer's Fracture
(Metacarpal Neck Fracture)

Pathology || Signs and Symptoms || Diagnosis || Treatment || Overview ||
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Pathology





A Boxer's fracture is a break in one of the metacarpal bones of the hand. They typically occur after punching something hard, hence the name "Boxer's" fracture (other commonly used names for the same fracture are "bar room fracture" and "brawler's fracture"). The most common metacarpal injured in this manner is the 5th one (ie: the "pinky" finger). However, the term Boxer's fracture can be applied to any metacarpal neck fracture.

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Signs and Symptoms

Generally, someone with a Boxer's fracture will present with swelling and bruising around the area of the fracture, as well as extreme pain with manipulation of the involved finger. Physical exam may reveal overlapping of the fingers when the patient is asked to make a fist; this finding suggests a rotational abnormality to the fracture.

An open cut or wound in the same area may indicate an "open" fracture (aka: "compound" fracture) in which the bone penetrates through the skin. Even if the bone is not directly visualized on physical exam, a high index of suspicion for an open fracture should be maintained, especially if a skin wound is present near the fracture site.

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Diagnosis

Diagnosis is made by x-ray. Usually, three views of the hand are obtained to better characterize the fracture. Anteroposterior, oblique, and lateral films are the most common x-ray views obtained.

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Treatment

Treatment depends on the severity of the fracture. Less severe fractures can be managed with closed reduction (ie: non-surgical) and an ulnar gutter splint.

Boxer's Fracture

More severe fractures require surgical management with pins placed in the bones to facilitate appropriate anatomical healing. Open fractures have a high risk of infection, and require aggressive irrigation of the wound to wash out any contaminates.

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Overview

A Boxer's fracture is a broken metacarpal neck. It commonly occurs after punching a hard object, and typically involves the metacarpal of the pinky finger. Symptoms are bruising, swelling, and pain with manipulation of the affected finger. Treatment depends on the severity of the fracture, and may involve splinting or surgical pinning.

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Related Articles

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References and Resources

(1) Bragg S. The boxers' fracture. J Emerg Nurs. 2005 Oct;31(5):473.

(2) Maitra A, Sen B. The boxers fracture: a simple and effective method of external splintage. Arch Emerg Med. 1990 Mar;7(1):52-4.

(3) Porter ML, Hodgkinson JP, Hirst P, et al. The boxers' fracture: a prospective study of functional recovery. Arch Emerg Med. 1988 Dec;5(4):212-5.

(4) Lee SG, Jupiter JB. Phalangeal and metacarpal fractures of the hand. Hand Clin. 2000 Aug;16(3):323-32, vii.

(5) Kozin SH, Thoder JJ, Lieberman G. Operative treatment of metacarpal and phalangeal shaft fractures. J Am Acad Orthop Surg. 2000 Mar-Apr;8(2):111-21.

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