boxer's fracture what is a boxer's fracture boxer's fracture is a broken bone of the hand normally occurs at the neck of the fifth met carbal it usually occurs when a striking a firm object it can be a wall or maybe the opponent during boxing usually that happen with a clinched fist the head of the metac carbal bone forms the knuckle during an enclosed fist the end of the fifth me caral takes the force of the impact and breaks at its neck and angulate towards the Palm creating a dorsal bump you can see here the fracture of the metac carbon neck patient who sustain a boxer fracture commonly complain of pain delling and the deformity at the base of the small finger the X-ray are needed to diagnose the fracture and the angulation of this fracture a true lateral radiograph is needed the normal metac carbal neck angle is 15° so if the angulation measures 40° on the xrays then it's actually 25° degre of real angulation the fracture usually displaces with dorsal angulation and the metac carbal head is displaced perly which can result in clawing here you can see the metac carbal and here you can see the neck of the metac carbal and also there is the samec joint the CC joint is the carbo carbal joint the second and the third CMC joints are not mobile if you break the second or the third met carbal neck the deformity is not acceptable because the carbo metac carbal joint is not mobile to accept some deformity you need to have compensatory mobility of the CMC joint compensatory movement takes place at the mobile CC joints of the fourth and the fifth fingers the movement is 10 to 15° in the fourth and 20 to 30° in the fifth and that can help in guiding the treatment less than 40° of the deformity in the fifth metac carbal shaft is acceptable less than 50 to 60° of angulation deformity in the fifth metac carbal neck is acceptable the suron is less likely to correct the deformity in the fifth metac carbal because there is a compensatory mobility of the CMC joint the patient may end by a bump at the knuckle but it usually doesn't affect the hand function practically speaking any deformity more than 50° require possible intervention to void sudo clowing treatment usually is splant that will allow the fracture to heal especially if the deformity is not severe you may need close reduction and dis splinting to improve the deformity apply the splint in the position of hand function which is extension of the rest and flexion of the mCP joint usually an under gutter plint is used boxer's fracture is usually angulated the angulation is usually tolerable and the outcome is usually good occasionally it have rotational deformity and if it has rotational deformity it will need to be corrected acceptable outcome is reported even when the angulation is as high as 50 60° when the majority of the factures are treated without surgery some studies found there is no difference in outcome in pain in satisfaction in range of motion in Gish strength when you compare body taping with splinting there is some opinion just give the patient body tape and schedule appointment as needed and you're going to do just fine with an optional up some doctors believe that the reduction the casting the scheduled appointment and more xrays may be unnecessary and maybe we adding a burden to the patient and to the health care so it seems like boxers fracture management may not be a big deal however some doctors believe the opposite that they should follow their patient closely sery is rarely done surgery is done utilizing K wires percutaneously intramed or we use percutaneous kwire fixation stabilizing the fifth metac carbal to the fourth metac caral thank you very much I hope that was helpful