Boxer's Fracture

General Considerations

• Common injury
• Classically, the neck of the 5^th metacarpal (little finger); sometimes 4^th metacarpal, when a hard object is hit with a clenched fist
• Most commonly occur in younger adult males
• Contrary to their name, they rarely occur in professional boxers but those who are “inexperienced” with punching someone/something
• Professional boxers strike with the heads of the 2^nd and 3^rd metacarpals and with the force transmitted linearly through the radius and ulna

Clinical Findings

• Pain
• Swelling
• Tenderness
• Loss of motion
• The knuckle appears “depressed”

Imaging Findings

• Transverse fracture across neck of 5^th metacarpal
• Frequently there is volar (palmar) angulation
• Usually not comminuted
• True lateral image is used to identify degree of volar angulation

Treatment

• Closed reduction
• Open reduction with K-wire
• Fractures of the metacarpal head usually dictates operative fixation

Prognosis

• Good 

 
Boxer's Fracture. There is a transverse fracture of the neck of the 5th metacarpal (red arrow) with palmar (volar) angulation.

Greer, SE; Williams, JM. "Boxer's fracture: an indicator of intentional and recurrent injury.". The American journal of emergency medicine. Jul 1999. 17 (4): 357–60.

Soong, M; Got, C; Katarincic, J. "Ring and little finger metacarpal fractures: mechanisms, locations, and radiographic parameters.". Aug 2010. The Journal of hand surgery 35 (8): 1256–9