A Boxer’s fracture is a break in the neck of the fifth metacarpal bone, which is the long bone in the hand connected to the pinky finger. This injury most commonly occurs when a person strikes a hard, unyielding object with a closed fist, transferring axial force directly through the knuckle joint. While often associated with the sport of boxing, the fracture frequently happens in instances like punching a wall. The fracture typically involves the distal end of the bone, near the knuckle, and is one of the most common types of hand fractures.
Recognizing the Symptoms and Seeking Medical Care
The injured area will likely display intense pain, noticeable swelling, and bruising on the pinky finger side of the hand. A visible deformity is common, where the knuckle may appear flattened or “missing” compared to the others, and there may be a bump on the back of the hand.
A specific symptom to watch for is rotational misalignment of the pinky finger. When the patient attempts to make a fist, the injured finger may cross over or tuck under the adjacent ring finger, a problem known as “scissoring.” This rotational issue can lead to long-term functional impairment if not addressed. Prompt medical assessment is necessary, as diagnosis is confirmed by X-rays, which determine the fracture’s exact location, degree of angulation, and stability. While waiting for care, applying the RICE protocol—Rest, Ice, Compression, and Elevation—can help manage swelling and pain.
Standard Non-Surgical Healing Methods
Most Boxer’s fractures can be successfully treated without surgery if the bone fragments are not severely displaced or rotated. If the bone fragments are significantly misaligned, a physician will perform a procedure called closed reduction. This involves manually manipulating the hand to set the bone back into an acceptable position. The goal is to minimize angulation, often aiming for less than 40 degrees in the fifth metacarpal neck, which is generally tolerated without functional loss.
Following reduction, or if the fracture was minimally displaced, the hand is immobilized using an ulnar gutter splint or a short arm cast. This device holds the metacarpophalangeal (MCP) joint in 70 to 90 degrees of flexion to prevent the collateral ligaments from shortening, which causes stiffness. The immobilization period usually lasts between three to six weeks, depending on the fracture’s stability and how quickly bone consolidation occurs. Follow-up X-rays are typically taken one to two weeks after the initial placement to confirm that the bone has maintained its alignment.
Factors Determining the Need for Surgery
Surgery is reserved for complex fractures where non-surgical methods are unlikely to yield a functional outcome. The primary indications for surgery include an open fracture, where the bone has broken through the skin, or a fracture that cannot be adequately reduced through closed manipulation. Any degree of rotational deformity, where the finger crosses over the adjacent digit when making a fist, is also a strong indication for surgery because it severely compromises hand function.
The degree of angulation is another major factor, with surgical fixation often recommended if the angulation exceeds 40 to 70 degrees. Additionally, excessive shortening of the metacarpal bone, generally more than 5 millimeters, may require surgical stabilization. The most common surgical approach is Open Reduction and Internal Fixation (ORIF). The surgeon realigns the bone fragments directly and secures them with small devices like pins, plates, or screws. Post-surgery, the patient enters an initial recovery phase focused on wound care and managing swelling through elevation.
Long-Term Recovery and Rehabilitation
Once the cast or splint is removed, the focus shifts entirely to restoring the hand’s function. It is common to experience significant stiffness in the finger joints and notable weakness in grip strength after weeks of immobilization. Physical therapy (PT) becomes a necessary component of recovery to address these issues.
The therapist guides the patient through a progressive series of exercises designed to regain full range of motion, focusing on tendon gliding exercises. Strengthening exercises, such as using putty, hand grippers, or resistance bands, are introduced once sufficient pain-free motion is achieved. Full functional recovery often takes an estimated eight to twelve weeks from the time of injury. Return to activities involving heavy gripping or impact should only occur once the hand has achieved full range of motion and strength comparable to the uninjured side, as advised by the physical therapist and physician.