Boxer's fracture
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Brawler's fracture
Overview
A boxer's fracture is the common name for a fracture at the neck of the fifth metacarpal bone.
Causes
It is usually caused by the impact of a clenched fist with an immovable object, such as a wall or skull. The pinky knuckle tends to lead the rest of the knuckles in a hard punch, and the knuckle compresses and snaps the head of the metacarpal bone.
Diagnosis
X Ray
On imaging, transverse fracture of the metacarpal neck, with volar angulation of the distal fragment is seen.
Treatment
Conservative Management
These fractures are often angulated, and if severely so require pins to be put in place and realignment as well as the usual splinting. However, the prognosis on these fractures is generally good, with total healing time not exceeding 12 weeks. The first two weeks will show significantly reduced overall swelling with improvement in clenching ability showing up first. Ability to extend the fingers in all directions appears to improve more slowly. Hard casts are rarely required and soft casts or splints can be removed for brief periods of time to allow for activities such as showers and "airing out" the casted or splinted area so as to avoid skin rotting and permit cleansing of the casted or splinted area. Pain from this injury is generally very mild and rarely requires medications beyond over the counter drugs such as ibuprofen or acetaminophen. Muscle atrophy in isolated areas of 5 to 15 percent should be expected with a rehabilitation period of approximately 4 months given adequate therapy. In the mildest of cases, full rehabilitation status can be achieved within 3 to 4 months.
For smaller angled fractures most discomfort is alleviated by raising the fracture above the heart, also if there is no cast warm water will relieve some of the pain. It is important that when the cast is removed that the hand is gently exercised by attempting the common functions of the hand. All advice has been given from fracture patients who first received treatment from an Orthopedic doctor, which in ideal cases should be consulted.
Primary Prevention
Boxers and other combat athletes routinely use hand wraps and boxing gloves to help stabilize the hand, greatly reducing pain and risk of injury during impact training such as working the heavy bag.
References
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