Learning Radiology xray montage

Boxer's Fracture


General Considerations

  • Common injury
  • Classically, the neck of the 5th metacarpal (little finger); sometimes 4th 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 2nd and 3rd 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 5th metacarpal
  • Frequently there is volar (palmar) angulation
  • Usually not comminuted
  • True lateral image is used to identify degree of volar angulation


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


  • Good 

 Boxer's fracture

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