A boxer's fracture is the

break Break or Breaks or The Break may refer to: Time off from duties * Recess (break), time in which a group of people is temporarily dismissed from its duties * Break (work), time off during a shift/recess ** Coffee break, a short mid-morning rest ...

of the 5th metacarpal bones of the hand near the

knuckle The knuckles are the joints of the fingers. The word is cognate to similar words in other Germanic languages, such as the Dutch "knokkel" (knuckle) or German "Knöchel" (ankle), i.e., ''Knöchlein'', the diminutive of the German word for bone ( ...

. Occasionally it is used to refer to fractures of the 4th metacarpal as well. Symptoms include pain and a depressed knuckle. Classically, it occurs after a person hits an object with a closed

fist A fist is the shape of a hand when the fingers are bent inward against the palm and held there tightly. To make or clench a fist is to fold the fingers tightly into the center of the palm and then to clamp the thumb over the middle phalanges; in ...

. The knuckle is then bent towards the palm of the hand. Diagnosis is generally suspected based on symptoms and confirmed with

X-rays An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nbs ...

. For most fractures with less than 70 degrees of angulation, buddy taping and a

tensor bandage An elastic bandage is a "stretchable bandage used to create localized pressure". Elastic bandages are commonly used to treat muscle sprains and strains by reducing the flow of blood to a particular area by the application of even stable pressur ...

resulted in similar outcomes to reduction with splinting. In those with more than 70 degrees of angulation or in which the broken finger is rotated, reduction and splinting may be recommended. They represent about a fifth of

hand fracture A hand is a prehensile, multi-fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the koala (which has two opposable thumbs on each "han ...

s. They occur more commonly in males than females. Both short and long term outcomes are generally good. The knuckle, however, typically remains somewhat deformed.

Signs and symptoms

The symptoms are pain and tenderness in the specific location of the hand, which corresponds to the metacarpal bone around the knuckle. When a fracture occurs, there may be a snapping or popping sensation. There will be swelling of the hand along with discoloration or bruising in the affected area. Abrasions or lacerations of the hand are also likely to occur. The respective finger may be misaligned, and movement of that finger may be limited and painful.

Causes

Metacarpal fractures are usually caused by the impact of a clenched fist with a hard, immovable object, such as a skull or a wall. When a punch impacts with improper form, the force occurs at an angle towards the palm, creating a dorsal bend in the bone, ultimately causing the fracture when the bone is bent too far. When a boxer punches with proper form, the knuckles of the second and third metacarpal align linearly with the articulating radius, followed linearly by the humerus. Due to the linear articulation of bones, the force is able to travel freely across these joints and bones and be dissipated without injury. Therefore, fractures of the second or third metacarpals are rare, with fractures of the 4th and 5th metacarpals comprising the vast majority of metacarpal fractures.

Diagnosis

Diagnosis by a doctor's examination is the most common, often confirmed by x-rays.

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

is used to display the fracture and the angulations of the fracture. A CT scan may be done in very rare cases to provide a more detailed picture.

Prevention

Boxers and other combat athletes routinely use hand wraps and

boxing gloves Boxing gloves are cushioned gloves that fighters wear on their hands during boxing matches and practices. Unlike "fist-load weapons" (such as the ancient cestus) which were designed as a lethal weapon, modern boxing gloves are non-lethal, desig ...

to help stabilize the hand, greatly reducing pain and risk of injury during impact. Proper punching form is the most important factor to prevent this type of fracture.

Treatment

Ice is applied to relieve pain and swelling. Any open wounds are cleansed to avoid infection. For most fractures with less than 70 degrees of angulation, buddy taping and a

resulted in similar outcomes to reduction with splinting. Conservative treatment with early mobilization has also been found non-inferior when compared to surgical treatment with bouquet pinning for fractures presenting with less than 45 degrees of palmar angulation. In rare cases when the fracture causes rotational deformity or severe angulation surgery may be required to place pins or plates in the bone to hold the pieces in place.Page 42
in:

Prognosis

Prognosis for 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 cleaning and drying the skin underneath the splint. Pain from injury varies person to person as with most injuries cannot, in all honesty, be generalized. Depending on the individual a course of over the counter or narcotic pain medication will suffice. Muscle atrophy of 5 to 15 percent may 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.

Epidemiology

Hand and wrist injuries are reported to account for fifteen to twenty percent of emergency room injuries, and metacarpal fractures represent a significant number of those injuries. Hand injuries of this sort are most prevalent among fifteen- to thirty-five-year-old males, and the fifth metacarpal is the one most commonly affected. Males are nearly fifty percent more likely to sustain fracture from a punch mechanism than females. Male intentional punch injuries are correlated predominantly with social deprivation, while female punch intentional injuries show more correlation with psychiatric disorders. Approximately 3.7 male hand injuries, per 1000, per year, and 1.3 female hand injuries, per 1000, per year, have been reported. Common mechanisms of injury are gender specific. Although the fiscal cost is not available, it can be asserted that the cost is reasonably significant per individual, depending on the cost of emergency care, immobilization, surgery, follow up doctors' visits, etc. in addition to the fiscal impact from loss of and/or limited work abilities.

Terminology

As these are colloquial terms, texts and medical dictionaries do not universally agree on precise meanings. Various authorities state that a "boxer's fracture" means a break in specifically the second metacarpal bone or third metacarpal bone, with "bar room fracture" being specific to the fourth metacarpal bone or fifth metacarpal bone. This is derived from boxers properly punching through the 2nd and 3rd knuckles, whereas inexperienced fighters often connect with the weaker 4th and 5th. Though some writers assert that boxer's fracture and bar room fracture are distinct terms representing injuries to different bones, this distinction seems to have been lost and most medical professionals now describe any metacarpal fracture as a "boxer's fracture".

References

External links

Boxer's fracture (Wheeless' Textbook of Orthopaedics)
{{Fractures Bone fractures Injuries of wrist and hand Sports injuries Wikipedia medicine articles ready to translate Boxing culture