Boxer’s Fracture

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Image Source: The New England Journal of Medicine©

What comes to mind when the diagnosis reads “Boxer’s fracture“?

A boxer got any of his bone fractured?

Paradoxically, an experienced boxer rarely gets a boxer’s fracture. It is most commonly seen in untrained individuals and inexperienced boxers who may get bone of the pinky finger fractured when punching a solid surface.

A blow on a desk/wall in frustration can land you in the emergency department.

Boxer’s fracture is an impaction injury, which results in minimally comminuted, transverse fractures of the 5th metacarpal (the pinky finger), usually occurring after a direct blow with a clenched fist against a hard surface, either a wall, faces, etc.

95% of the boxer’s fracture is seen in males.

Here is a case example of a boxer’s fracture:

A 56-year-old man punched the desk in frustration at work. Thereafter, he felt acute pain in his right hand (dominant hand) due to which he presented to the emergency department.

On examination, there was no visible wound, but the base of the fifth (pinky) finger was swollen.

An angulated (angulation of greater than 30 degrees) fracture of the neck of the fifth metacarpal was seen on the plain radiograph (Xray) of the right hand.

The fracture was managed with percutaneous intramedullary nail fixation and cast immobilization. At follow-up 5 months, the patient regained full use of his right hand.

The name given to this fracture is derived from the mechanism of injury. Punching imparts axial pressure on the metacarpal bone of the fifth finger, causing it to break. Boxer’s fracture comprises 10% of all the hand fracture. Overall, 40% of all hand fractures are metacarpal neck fractures.

Boxer’s fractures are most commonly seen in men with a male to female ratio of 5:1. Men of ages 10 to 19 years have the highest incidence of boxer’s fracture.

Management of the boxer’s fracture depends upon the fracture. Fractures that are closed, non-displaced without angulation or rotation are treated with immobilization and ulnar splint. Open, angulated, malrotated fractures, or those with neurovascular injury are managed surgically. Early mobilization has reported being beneficial. Active and passive movements prevent stiffness of the joints. There may be some residual cosmetic deformity even after an adequate reduction of the fracture.

Also, it is imperative to rule to fight bite if the fracture resulted from blow to human face as an additional treatment for a human bite will be required too.

The overall healing takes around 4 to 6 weeks. After one week of management, a plain radiograph should be repeated to evaluate the alignment; after that, fortnightly radiographs are done until healing is evident both clinically and radiographically.

Occupational therapy should be considered if there is no complete restoration if function even after several weeks of the hand exercises.

References

Naoki Yoshida, M. a. (2019, September 05). Boxer’s Fracture. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1813737

Malik S, Herron T, Rosenberg N. Fifth Metacarpal Fractures (Boxer’s Fracture) [Updated 2020 Apr 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470428/


Meals C, Meals R. Hand fractures: a review of current treatment strategies. J Hand Surg Am. 2013 May;38(5):1021-31; quiz 1031

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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