How is a boxer’s fracture treated? What are the important considerations in managing this type of hand injury? Get the answers to these questions and more in this detailed guide.

Understanding Boxer’s Fracture

Boxer’s fracture, also known as a fracture of the fifth metacarpal neck, is one of the most common hand fractures, accounting for 10% of all hand fractures. This injury typically occurs when direct trauma is applied to a clenched fist, such as when punching an object. Unlike other hand and wrist fractures, a boxer’s fracture usually does not result from a fall onto an outstretched hand.

Epidemiology and Risk Factors

The incidence of metacarpal neck fractures presenting for hospital care in the United States is 13.6 per 100,000 person-years. Metacarpal fractures account for 40% of all hand fractures, with the fifth metacarpal neck fracture being the most common subtype. The incidence in males is five times higher than in females, with the highest rates seen in males aged 10 to 19 and 20 to 29. These injuries commonly occur at home and during sporting or athletic events.

Pathophysiology and Anatomy

The fifth metacarpal bone is one of the five metacarpal bones in the hand. Axial load from direct trauma to a clenched fist transfers energy to the metacarpal bone, most commonly causing a fracture at the neck. This typically results in apex dorsal angulation due to the pull of the interosseous muscles, which originate from the metacarpal shafts and insert onto the proximal phalanges. The collateral ligaments that join the metacarpal bones to the proximal phalanges must also be considered during splinting to minimize the risk of loss of motion due to shortening.

Clinical Presentation and Evaluation

Patients with boxer’s fractures typically present with complaints of dorsal hand pain, swelling, and possible deformity. A complete physical exam should include an assessment of the range of motion, neurovascular status, and any associated injuries. Imaging studies, such as radiographs, may be necessary to confirm the diagnosis and evaluate the extent of the fracture.

Treatment Options

The treatment for a boxer’s fracture depends on various factors, including whether the fracture is open or closed, the degree of angulation, rotation, and the presence of any concomitant injuries. Conservative management with an ulnar gutter splint may be appropriate for closed, non-displaced fractures without significant angulation or rotation. However, open fractures, severely angulated or malrotated fractures, or those involving neurovascular structures may require surgical intervention by a hand surgeon.

Interprofessional Team Approach

Effective management of boxer’s fractures requires a coordinated effort from an interprofessional team, including emergency physicians, orthopedic surgeons, physical therapists, and nursing staff. This team approach helps ensure a comprehensive evaluation, appropriate treatment, and optimal outcomes for patients with this common hand injury.

Frequently Asked Questions

What is the most common mechanism of injury for a boxer’s fracture?
The most common mechanism of injury for a boxer’s fracture is punching, where the axial pressure is applied to the metacarpal bone when the fist is in a clenched position.

How are boxer’s fractures treated?
Treatment for a boxer’s fracture depends on the characteristics of the fracture, such as whether it is open or closed, the degree of angulation, and the presence of any other injuries. Conservative management with an ulnar gutter splint may be appropriate for closed, non-displaced fractures, while open fractures or those with significant angulation or malrotation may require surgical intervention.

Why is it important to involve an interprofessional team in managing boxer’s fractures?
An interprofessional team approach, including emergency physicians, orthopedic surgeons, physical therapists, and nursing staff, helps ensure a comprehensive evaluation, appropriate treatment, and optimal outcomes for patients with boxer’s fractures. This coordination of care is crucial for managing this common hand injury.