Boxer's Fracture

Broken Hand Bone Often Sustained By Punching

Man and woman exercising with punchingballs
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The boxer's fracture is a broken bone of the hand, classically at the base of the small finger finger. The boxer's fracture is a break that occurs in the region of the bone called the metacarpal neck. The metacarpal is the bone in the palm of the hand that extends from the small bones of the wrist to the knuckle at the base of the finger. The site of the break in a boxers' fracture is near the knuckle.

Most often boxer's fractures are seen after punching a person or an object such as a wall. While the injury is most often a punching motion, one can also sustain this injury with non-punching types of injuries. Other causes can be from trying to break a fall with your hand, having your hand crushed in an accident, violent twisting of the hand or finger, or from contact during sports.

Signs of a Boxer's Fracture

Patients who sustain a boxer's fracture commonly complain of pain and swelling at the base of the small finger. A deformed appearing knuckle is also a common sign of boxer's fracture. There is also often a bump over the back of the palm just below the small finger knuckle. The knuckle itself may look sunken in, or absent. The best way to see the deformity is by making a fist with both hands, and comparing the appearance of the backs of your hands. The hand with a boxer's fracture will have a different shape to the outer side of the hand.

In the early stages after the injury, the deformity of the hand may be hard to discern, as swelling can make the side of the hand look deformed.

The most common signs of the boxer's fracture are:

  • Pain on the outer side of the hand
  • Tenderness over the small finger knuckle
  • Difficulty forming a fist
  • Swelling and bruising
  • Deformity of the hand

If you think you may have broken your hand, you should be seen by your doctor. Your doctor is likely to obtain an x-ray if there is concern about a possible fracture. Other tests should not be necessary to diagnose a boxer's fracture. Your doctor will assess for other injuries that may have occurred, and evaluate the extent of the deformity of the fracture.

Treatment of a Boxer's Fracture

Depending on the severity of the boxer's fracture, these can be treated by splinting, taping, casting or surgery. Most boxer's fractures can be treated nonsurgically. In these situations, there is some controversy about the best method of treatment. The advantage of casting and splinting is that the fracture is well protected to prevent discomfort from bumping the injured hand into things. The advantage of taping is that early mobility tends to lead to less stiffness of the knuckles, one of the most common complications of this injury.

There is also great debate about how much deformity is acceptable with this injury.

It is intuitive to think that aligning the bones into proper position is best, however, that may not be the case. Resetting the fracture without doing surgery isn't likely to accomplish too much. Most often, the pull of the finger tendons leads to a recurrence of the deformity of the bone unless the fracture is stabilized with pins or screws. That said, the scarring and stiffness that occurs from surgery may be worse than the deformity of the original injury. I often explain to my patients that surgery is trading a bump for a scar. Yes, it is true that leaving the fracture alone may lead to a permanent bump on the back of the hand, but surgery is likely to lead to stiffness and scarring.

If surgery is needed, the usual treatment is to insert small pins through the skin to secure the bones in place. These may remain in after the bone has healed or they may be removed.

Regardless of the treatment, it is common for finger injuries around the knuckles to have stiffness and discomfort once healed. Therefore, once your doctor allows, you should begin exercises to regain normal mobility of the hand.

Source:

Hand Fractures, American Society for Surgery of the Hand, October, 2007.

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