A boxer’s fracture is a break through the bones of the hand that form the knuckles. Other names for this condition include, ‘metacarpal fracture’, ‘metacarpal neck fracture’, and ‘hand fracture’. A boxer’s fracture is a break in a metacarpal bone that connects the ring finger or the little finger to the wrist (also known as the fourth and fifth metacarpal bones). Most doctors also include breaks in the neck of the second and third metacarpal bones in the definition of a boxer’s fracture. The second metacarpal bone connects the index finger to the wrist, and the third metacarpal connects the middle finger to the wrist.
The metacarpal bones in the hand connect the bones in the finger to the bones in the wrist. There are a total of five metacarpal bones; one to connect each finger to the wrist. All of the metacarpal bones have the same anatomic structure. Each consists of the base, the shaft, the neck, and the head, as described below:
- Base – The base of the metacarpal bone is the portion that attaches to the bones of the wrist.
- Shaft – The shaft is the long, slender portion of the bone.
- Neck – The neck is the portion of the bone that connects the shaft to the head. The head of the metacarpal bone connects the metacarpal bone to the bone of the finger.
- Head – The head of the metacarpal bones forms the knuckle of an enclosed fist.
Causes & Symptoms
Boxer’s fracture gets their name from one of their most common causes, which is punching an object with a closed fist. This can happen during fistfights or from punching a hard object such as a wall or filing cabinet. Although less common, this type of fracture can also happen when the hand isn’t clenched and strikes a hard object.
The usual symptoms of a boxer’s fracture are pain or tenderness centered in a specific location on the hand corresponding to one of the metacarpal bones, around the knuckle. The person may also note pain with movement of the hand or fingers. When a bone is broken, a snapping or popping sensation in the affected bone may be experienced. The hand may also swell, discolor, or bruise around the injury site. Deformity of the broken bone or the knuckle also may be noted. There may be an abnormal movement of the broken bone fragments.
The doctor may be able to produce pain by pressing on the broken bone. In addition, pain can be produced by grabbing the finger that attaches to the metacarpal bone that was hurt and pushing it inward toward the broken bone. If a fist is made with the affected hand, the doctor may notice a misalignment of the associated finger. The doctor may see a deformity of the broken bone.
When making a fist, the finger involved may bend toward the thumb more than is usual. This is known as a rotation, and, though not always seen, its presence may indicate the possibility of a more serious type of boxer’s fracture. Another common sign of a possible boxer’s fracture is a cut on the hand. A cut in the skin associated with a boxer’s fracture may indicate a more serious type of boxer’s fracture.
Other symptoms for boxer’s fracture include the following:
- Little finger looks bent.
- A sudden feeling of a tingling sensation.
- The area around the little finger feels numb and cold.
- Limited range of motion of the hand.
- Difficulty forming a fist.
- Difficulty gripping or inability to grip without pain.
Who gets Boxer’s Fracture?
Athletes who play contact sports, such as boxing, martial arts, football, basketball, hockey, and rugby are at a higher risk for boxer’s fractures. The injury is typically caused by a fall onto the hand, direct contact with an opponent on the playing field, or other trauma to the hand, like punching. Elders are also prone to experiencing a boxer’s fracture due to wear and tear, including osteoporosis (decreased bone density).
How Does it Affect You? How Serious is it?
Complications of a boxer’s fracture may include the following:
- Osteoarthritis – Fractures that extend in a joint can cause arthritis years later; if your hand starts to hurt or swell long after a break.
- Ongoing stiffness, aching, or disability – Stiffness, pain, or aching in the affected area generally goes away eventually after your cast is removed or after surgery. However, some people have permanent stiffness or pain.
- Nerve or blood vessel damage – Trauma to the hand can injure adjacent nerves and blood vessels. It is recommended to seek immediate attention if you have numbness or circulation problems.
Other complications include developing a permanently crooked finger.
In severe cases, a boxer’s fracture may need surgery. An injured patient with a boxer’s fracture that requires operative stabilization is taken to the operating room and either sedated or placed under general anesthesia to relax the patient and allow the fracture to be manipulated. Sometimes the fracture ends can be realigned and pinned without a large incision.
Many times however, an incision is needed and direct visualization of the fracture ends is achieved. The fracture is realigned (reduced) under direct visualization and then fixed in place with pins, screws or plates, and screws (open reduction internal fixation).
Recommended Treatment & Rehabilitation
During a diagnosis of a boxer’s fracture, your doctor will ask you what happened to cause the injury and they will perform a physical exam afterward. They will look for factors, such as:
- Decreased ability to move the hand.
- Unequal temperatures between the injured and uninsured hands.
Swelling and discoloration are common with fractures. This is because of direct trauma to the bone and surrounding muscles, ligaments, tendons, nerves, and blood vessels. Next, your doctor will ask you to make a fist to check your ability to move your hand. This helps determine the extent of the injury, as well as the type of treatment that may be required. The doctor may also be able to determine if a ligament has been torn. Torn ligaments will not appear on standard X-rays. If they suspect a fracture, they will use an X-ray of your hand to check.
Normally, the X-rays look at the hand from three different directions. Getting images from different angles makes it easier for the doctor to see possible fractures. They should be able to see if there’s a break and if so, tell what type it is. Oftentimes, the doctor may order more X-rays, with special views to look for hard-to-find fractures.
Depending on how the injury occurred, it is possible the X-rays will show an object (also known as a foreign body) in your hand. Foreign bodies that may appear on X-rays are glass, bone, metal, and stones. This could occur if the injury came from punching another person in the mouth, being bitten by an animal, having something go through your hand, and being cut with a sharp object.
If a boxer’s fracture is detected, the primary goals of treatment are to immobilize the hand to permit proper healing and to alleviate the pain associated with fractures. In order to properly immobilize most broken bones, the splint should immobilize the joints above and below the site of the injury. In the case of a boxer’s fracture, however, different types of splints may be used. One type of splint may extend from the fingers, with the fingertips exposed to the forearm near the elbow.
Another type of splint that has been shown to be effective for some boxer’s fractures of the little finger is to buddy-tape the ring finger and little finger together. The doctor will decide what type of splint will treat the patient’s fracture.
When a boxer’s fracture occurs, it is possible for a portion of the metacarpal bone to move out of normal alignment. This is called angulation. The amount of angulation will determine what type of treatment is required to ensure proper healing. Patients with boxer’s fractures who have acceptable amounts of angulation may be splinted in the emergency room or doctor’s office.
Any degree of angulation in the second or third metacarpal bones is considered abnormal and requires referral to a hand specialist for possible surgical repair. Boxer’s fractures of the fourth and fifth metacarpal bones only require surgery if large degrees of angulation are present, and the bones cannot be moved into the correct place by pulling and pushing on them.
Because broken bones can cause significant amounts of pain, pain management is an important aspect of treating broken bones. Pain management is best accomplished with anti-inflammatory medications and pain relievers. Acetaminophen or ibuprofen typically provides good pain relief with few side effects.
After the fracture heals, and the immobilizer is removed, it is common to experience loss of hand strength, loss of grip strength, and reduced motion and ability to move the finger and wrist. A physiotherapist can provide hands-on techniques to help improve motion and any residual pain, as well as teach patients exercises to improve grip strength, wrist strength, and motion of the fingers and wrist. Along with the hand, the strength of other muscles, such as those around the elbow and shoulder, can be affected since the activity of the injured arm is limited with the hand injury.
Below are a few hand exercises for you to try. These exercises will slowly help reduce further symptoms linked to boxer’s fracture:
Wrist flexion and extension
Place your forearm on a table. Your affected hand and wrist should extend beyond the table, palm down. Next, bend your wrist to move your hand upward and allow your hand to close into a fist. Now, lower your hand and allow your fingers to relax. Hold each position for about 5 seconds before repeating 8-12 times a day.
Radial and ulnar deviation
First, grasp a water bottle with your affected hand. If you do not have something to hold on to, make a fist instead. With your elbow on a table, slowly bend your wrist upward. Then, lower your wrist back to where you started. Repeat this method 8-12 times a day.
Place a small towel roll on a table. Afterwards, with your palm facing down, grab the towel. Squeeze it for about 6 seconds, then slowly straighten your fingers to release the towel. Repeat this exercise 8-12 times a day.
Pronation and supination stretch
Grasp a pen, pencil, or stick, and wrap your hand around it. If you do not have something to hold on to, make a fist instead. Then, lift your arm so that your elbow is at your side, bent at a 90-degree angle. Slowly turn your forearm as far as you can back and forth in each direction. Your hand should face up and then down. Hold each position for at least 15-30 seconds until you feel a stretch in your forearm. Repeat this method 2-4 times a day.
Alternative & Homeopathic Treatment
Certain homeopathic treatments for a boxer’s fracture can increase a huge amount of support for the recovery of this condition. The immediate goals of caring for an injured hand are to minimize pain, swelling, and the risk of infection of any open cuts. Some of these treatments include the following:
- Ice and elevation – The best approach to reduce pain and swelling is to apply an ice pack to the injured area. If ice isn’t available, placing a towel soaked in cold water on the injured hand will work as well. Elevating the injured hand will also help reduce swelling.
- Immobilize the hand – This helps prevent further injure from a fracture. You can do this by holding the injured hand in the uninjured hand.
- Clean and treat cuts – An open cut suggests an open fracture. This type of break is at higher risk for infection and poor healing. All cuts should be washed with soap and water and then covered with a clean bandage right away.