II. Definitions
- Boxer's Fracture
- Fracture of neck of Fifth Metacarpal (little or pinky finger)
III. Mechanism
- Often injured in fist fights
IV. Signs
- Swelling over Fracture
- Depression of involved knuckle
V. Imaging: Hand XRay
- Distal Fracture fragment with volar angulation
- Maximum acceptable angulation: 40 degrees
- Reduction should aim to minimize angulation
VI. Management
- Impacted Fracture with minimal angulation
- May be effective even for angulation up to 70 degrees
- Compression dressing for 1 week
- Then gradually increase Exercises
- Statius (2003) Arch Orthop Trauma Surg 123:534 [PubMed]
-
Fracture angulated greater than 40 degrees
- Consider reduction even for <40 degree angulation
- Closed Reduction (see below)
- Immobilization as described below
- Open Reduction and Internal Fixation (ORIF)
- Indicated for persistent angulation >40 degrees
VII. Management: Closed Reduction
- Anesthesia: Hematoma Block or Ulnar Block
- Procedure
- Flex at affected MCP joint to 90 degrees
- Stabilize proximal Metacarpal
- Direct pressure dorsally at distal angulated fragment
- Immobilization
- Splint MCP in 70-90 degrees flexion for 6 weeks
- Ulnar Gutter Splint or glove cast
- Follow-up
- Repeat XRay every 2 weeks to evaluate healing
- Exercises start after immobilization
- Return to play recommendations (variable guidelines)
- Consider waiting until symmetric strength and ROM
VIII. Orthopedic referral indications
- Angulation >40 degrees
- Rotation (evaluated with XRay or Hand Exam)
IX. Complications: Excessive volar angulation
- MCP stiffness or pain
- Persistent protruding bump at MCP
- May occur even without significant angulation
X. Prognosis
- Good functional result even with some angulation
- Knuckle will never appear as prominent