Boxer's fracture: Treatment, diagnosis, and recovery
This kind of hand fracture is caused by an impact to the knuckle and is the most common type of metacarpal fracture. The severity of the injury depends in part on how much of the metacarpal bone is damaged.
Metacarpal bones consist of a base, shaft, head, and neck. The base is the part that attaches to the bones of the wrist. The shaft and neck portions of the bone run through the hand towards the fingers. The head of a metacarpal bone connects it to the bone of the finger. The heads of the metacarpal bones form the knuckles of the fist.
- The fracture typically occurs in the neck of the metacarpal, which connects the main shaft of the bone to the head.
- The term was originally used to describe only breaks in the fifth metacarpal, which is the bone of the little finger.
- This is the most common break when someone hits a hard or immoveable object.
- Treatments vary depending on the severity of the injury.
Boxer's fracture definition
The definition has been expanded to include many metacarpal bone fractures caused by similar impacts.
Boxer's fracture should not be confused with boxer's knuckle, which is caused by repeated damage to the ligaments over time.
Causes of boxer's fracture
Boxer's fracture is so called because it is commonly caused by direct imapct to the knuckles, for example when punching something.
As the name would suggest, a boxer's fracture is frequently caused by punching something. The knuckles are not designed to handle such impact, and fractures are a common consequence of a fight or someone punching a wall or other hard surface.
It is possible to get a boxer's fracture without throwing a punch, however. Smacking a flat hand against a hard surface can be enough to cause a fracture, as well as dropping something heavy on the knuckles.
Symptoms of a boxer's fracture usually follow a similar pattern to those of other broken bones. Symptoms of a boxer's fracture include:
- swelling on both sides of the hand, typically appearing soon after the trauma
- pain surrounding the area
- extreme tenderness near the broken bone
- limited mobility in the fingers
- snapping or popping sensation in the affected bone
- deep or painful bruises
- difficulty gripping or inability to grip without feeling pain
- nerve symptoms, such as numbness, coldness, or tingling sensation
Symptoms usually begin quickly after the break, with most being felt within the first 24 hours. A boxer's fracture needs medical attention. If a doctor cannot be reached for instruction, a person should go to the emergency room.
A boxer's fracture may be diagnosed using an X-ray.
Image credit: Roberto J. Galindo, (2010 February 23).
Diagnosing a boxer's fracture usually requires a physical examination and imaging tests.
A doctor will ask how the injury happened, to narrow down the possibilities quickly, especially if the hand is too swollen to tell what is damaged.
Doctors use a few methods, during a physical exam, to help them identify the fracture. They may:
- Put slight pressure on each bone to determine where the break is.
- Gently push each finger towards the knuckle to see, which causes pain and determine where the injury is.
- Ask the person involved to make a closed fist. The affected finger or fingers may look misaligned with the others. The affected fingers may also rotate towards the thumb more than normal.
Imaging tests are ordered, as well, even if the doctor is sure of their diagnosis. This is typically an X-ray image, which can confirm or determine, which bone is broken. Confirming the diagnosis through X-ray is critical, as treatment can vary greatly, again, depending on, which bones in the hand are damaged.
What are the treatment options?
Boxer's fracture seems simple and straightforward. Yet the injury can vary greatly in severity and may include one or more other broken bones. Treatment is not as straightforward as many other fractures. There are many different options that will be discussed with someone before moving forward.
Immediately after a fracture is suspected, it is important to reduce swelling and pain, and reduce the chances of infection. Ice packs can be used to limit swelling and pain.
It is important to immobilize the hand, as soon as possible. When the injury is unknown, it may be best to simply hold the injured hand in the non-injured hand, to keep it still. Any actions that put any stress on the hand at all should be avoided until the injury can be diagnosed.
After diagnosis, home care will often include cast or splint care, pain management, and checking for signs of infection.
Treatment options for boxer's fracture can include immobilization through splints or casts and might necessitate surgery. This depends on the severity of the fracture. Medical treatment will also include pain control.
The primary goal for medical treatment of a boxer's fracture is to immobilize the hand to allow the bones to heal properly. Doctors usually employ various splints to do this job, though casts may be necessary, as well. The splint or cast should completely immobilize the joints above and below the site of the injury. This keeps stress off the injured bone and allows it to heal.
Cases of a more severe boxer's fracture will require surgery. This is especially true in instances where bones show signs of angulation. Angulation occurs when a part of the metacarpal bone moves out of its normal alignment. The amount of angulation can change the treatment method. Minor angulation may simply require a splint, but stronger degrees of angulation may require surgery.
In all cases of boxer's fractures, people will be asked to follow up with an orthopedic surgeon. The surgeon will check if the healing is progressing well and help decide if surgery is needed to mend the bones.
What is the recovery outlook?
Physical therapy may be needed to help the hand to recover, and restore motor skills.
The recovery time will vary based on how severe the injury is. A simple fracture may heal in several weeks, where more severe fractures can take months to do so.
During the recovery period, it is important to regularly check in with a doctor and hand specialist to track the healing process. The treatment plan they lay out should always be followed to ensure proper healing. Any at-home exercises or physical therapy that doctors prescribe will be imperative for proper recovery and should be closely followed.
Some people find splints irritating and are tempted to take them off. Keeping the splint on at all the times that are recommended by a doctor gives the fracture the best chance of healing without complication.
Complications and outlook
Left untreated, a boxer's fracture can create complications for someone, such as leaving them unable to grip objects, with crooked fingers, or decreased range of motion.
On the other hand, a boxer's fracture that is quickly diagnosed and treated will usually heal with little to no long term effects. Proper medical diagnosis and treatment is critical for good healing and to ensure the best outcome.