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Understanding Boxer's Fracture and Treatment

Apr 22, 2025

Boxer's Fracture

Definition

  • A boxer's fracture is a broken bone in the hand, typically occurring at the neck of the fifth metacarpal.
  • Commonly occurs when striking a firm object (e.g., wall, opponent) with a clenched fist.

Anatomy

  • The head of the metacarpal bone forms the knuckle in a closed fist.
  • The fifth metacarpal absorbs the impact and breaks at its neck, angling towards the palm, creating a dorsal bump.

Symptoms

  • Pain, swelling, and deformity at the base of the small finger.

Diagnosis

  • X-rays are essential for diagnosing the fracture and any angulation.
  • A true lateral radiograph is required.
  • Normal metacarpal neck angle: 15°.
  • Angulation > 40° on X-rays indicates a 25° real angulation.

Displacement

  • Fractures displace with dorsal angulation.
  • The metacarpal head may displace medially, causing clawing.

Joint Mobility

  • Carpometacarpal (CMC) Joint:
    • The second and third CMC joints are immobile; therefore, deformities in these areas are not acceptable.
    • Compensatory mobility occurs in the fourth and fifth fingers, aiding treatment.
    • Fourth CMC joint: 10-15° mobility.
    • Fifth CMC joint: 20-30° mobility.

Treatment Guidelines

  • Acceptable Deformity Angles:
    • Fifth metacarpal shaft: <40°.
    • Fifth metacarpal neck: <50-60°.
  • Severe deformities (>50°) may require intervention to avoid pseudo-clawing.
  • Treatment Options:
    • Splinting to allow healing.
    • Closed reduction and splinting to improve the deformity.
    • Splint in the position of hand function: wrist extension, MCP joint flexion.
    • Ulnar gutter splint often used.

Outcomes and Considerations

  • Angulation is usually tolerable; outcomes are typically good.
  • Rotational deformities need correction.
  • Acceptable outcomes reported even with high angulation (50-60°).
  • Some studies show no difference in outcomes between body taping and splinting.
  • Minimal intervention suggested by some doctors to reduce patient burden.

Surgical Intervention

  • Rarely performed.
  • Surgery involves K-wires, either percutaneously or intramedullary, stabilizing the fifth to the fourth metacarpal.
  • The lecture suggests that management of a boxer's fracture is often straightforward and the prognosis is generally positive without surgery.

Note: This summary provides an overview based on the lecture content regarding boxer's fractures. Always consult medical professionals for detailed guidance and personalized treatment plans.

Full transcript