A Boxer’s fracture is a common break in the fifth metacarpal, the long bone connecting the little finger to the wrist. The fracture typically occurs at the “neck” of the bone, just below the knuckle. It is named for its frequent cause: an impact delivered with a closed fist, such as punching a hard object. Immediate attention is required to prevent poor healing and long-term functional issues.
Immediate Care and Medical Assessment
The first response to a suspected Boxer’s fracture is managing swelling and pain while protecting the hand. Following the R.I.C.E. protocol (Rest, Ice, Compression, and Elevation) helps reduce initial symptoms. Keeping the hand elevated above the heart minimizes swelling until medical help is available. Professional medical evaluation is necessary, especially if the finger appears crooked, pain is severe, or open cuts are present.
A doctor performs a physical examination to check for tenderness, swelling, and rotational deformity. Rotational alignment is assessed by having the patient make a fist, ensuring fingers point correctly without overlapping. X-rays confirm the diagnosis and provide specific details about the break. The images show the fracture location and measure the degree of angulation (bending of the bone fragments). The severity of angulation and rotational misalignment determine the appropriate course of treatment.
Non-Surgical Treatment Options
Non-surgical management is the standard treatment for most Boxer’s fractures, especially when angulation is within an acceptable range and rotational deformity is absent. The fifth metacarpal tolerates greater angulation than other hand bones due to its natural joint mobility. Angulation up to 30 or 40 degrees is often considered functionally acceptable without intervention.
If angulation exceeds the acceptable limit, closed reduction is performed to realign the bone fragments without surgery. This involves the physician manually manipulating the bone back into position, often using local anesthesia. After successful reduction or for well-aligned fractures, the hand is immobilized using a cast or an ulnar gutter splint. The splint holds the wrist in slight extension and the metacarpophalangeal (MCP) joint—the knuckle—in a flexed position (70 to 90 degrees).
Immobilization usually lasts three to six weeks, allowing the bone fragments to heal and stabilize. Follow-up appointments are scheduled, often within the first week, for repeat X-rays. These images ensure the reduced fracture has not shifted alignment inside the splint. For minimally displaced fractures, a simpler approach using a soft wrap and buddy taping may allow for earlier protected movement.
Surgical Intervention and Rehabilitation
Surgery is necessary when the fracture is too unstable, displaced, or complex for splinting alone. Indications include severe angulation that cannot be maintained by closed reduction, rotational deformity causing finger overlap when making a fist, or an open fracture. An open fracture, particularly one resulting from a “fight bite,” carries a high infection risk and requires urgent surgical cleaning and stabilization.
Surgical techniques stabilize the bone fragments to ensure proper healing and alignment. This may involve closed reduction with percutaneous pinning, where small metal wires (K-wires) are inserted through the skin to hold the fragments. Alternatively, Open Reduction and Internal Fixation (ORIF) uses an incision to access the fracture directly. The surgeon fixes the bone with small plates and screws, providing strong stability that can facilitate an earlier start to rehabilitation.
Rehabilitation
Rehabilitation is a fundamental part of the recovery process, regardless of whether treatment was surgical or non-surgical. Once immobilization is complete and the fracture is stable, a physical or occupational therapist guides the patient through a structured program. The initial focus is restoring range of motion to the fingers and wrist, which often become stiff after weeks of immobilization. This involves gentle active and passive exercises to regain full joint flexibility.
As healing progresses, the program advances to strengthening exercises designed to rebuild grip strength and dexterity. These activities are crucial for returning to normal daily tasks and sports. While the bone achieves solid union in six to ten weeks, complete recovery of strength and function may take three months or longer, especially after surgery. Consistent adherence to prescribed hand therapy is the most important factor for achieving an optimal long-term outcome.