A Boxer’s fracture is a break in the neck of the fifth metacarpal bone, which connects the wrist to the knuckle of the pinky finger. This injury most often occurs when a person strikes a hard, immovable object with a closed fist, transferring significant axial force through the hand. The fracture typically results in a characteristic angulation of the bone, with the top portion bending toward the palm. Immediate professional medical evaluation is required for accurate diagnosis and appropriate treatment planning.
Immediate Care and Initial Assessment
Initial care focuses on reducing pain and managing swelling and bruising. Following the R.I.C.E. principles—Rest, Ice, Compression, and Elevation—helps minimize tissue damage and discomfort. The injured hand should be elevated above the heart, and ice should be applied to limit the inflammatory response.
Upon arrival, the assessment begins with a physical examination to check for open wounds, nerve damage, or signs of rotational deformity. X-rays are required to confirm the fracture and determine its severity. These images allow the doctor to precisely measure the degree of angulation and evaluate for any significant shortening of the metacarpal. These measurements dictate the subsequent treatment path, determining whether the fracture can be treated non-surgically or if it requires an operation.
Non-Surgical Realignment and Immobilization
Non-surgical treatment is the standard approach for the majority of Boxer’s fractures, focusing on repositioning and stabilizing the bone fragments. If the angulation is too severe (typically 30 to 40 degrees), a procedure called “closed reduction” is performed. This manipulation is done under local anesthesia, where the doctor gently applies traction and pressure to realign the fractured bone ends without making an incision.
After successful realignment, the hand is immobilized in a cast or splint to hold the bone in the corrected position. The ulnar gutter splint is the most common type used, supporting the ring and little fingers. This splint is typically molded with the metacarpophalangeal (MCP) joints (the knuckles) flexed to 70-90 degrees, a position that helps prevent joint stiffness. Immobilization is maintained for three to six weeks, allowing the fracture fragments to form a solid bony union.
Surgical Options for Severe Fractures
In a minority of cases, the fracture is too unstable or severely displaced for non-surgical methods, necessitating surgical intervention. Indications for surgery include extreme angulation (often exceeding 60 to 70 degrees) or a significant rotational deformity that could cause the fingers to cross when making a fist. Open fractures, where the bone has broken through the skin, also require immediate surgery to clean the wound and prevent infection.
The goal of the operation is to achieve a stable reduction of the bone fragments. Common surgical techniques involve inserting fixation hardware to hold the bone in place during healing. This may include percutaneous K-wires (Kirschner wires), which are thin metal pins inserted across the fracture site, or small plates and screws for more complex breaks. These devices provide a rigid structure, allowing the bone to mend properly.
The Recovery and Rehabilitation Process
The recovery and rehabilitation process is essential for regaining full hand function. Once the cast or splint is removed, the hand and fingers are often stiff due to prolonged immobilization. This stiffness is managed through a structured program of physical therapy, often called hand therapy, which should begin as soon as the doctor permits.
Therapy focuses on restoring the full range of motion and strength. Early exercises include gentle active range-of-motion movements, such as finger flexion and extension, and tendon gliding exercises. As healing progresses, the program incorporates resistive exercises, like squeezing putty or hand grippers, to rebuild grip strength. A return to normal daily activities typically ranges from six to eight weeks, though a full return to strenuous activities or contact sports may take up to twelve weeks.