A boxer’s fracture is a common hand injury involving a break in one of the metacarpal bones, which connect the fingers to the wrist. It most often refers to a fracture of the neck of the fifth metacarpal (pinky finger), though it can sometimes affect the fourth metacarpal. This injury typically occurs when a closed fist impacts a hard object, or from falling onto a clenched fist. Prompt medical attention is important for proper healing.
Immediate Care
Immediately after a suspected boxer’s fracture, several steps can help manage the injury before professional medical help is obtained. Rest the injured hand and avoid any movement that causes pain. Applying ice packs to the affected area can help reduce swelling and discomfort. Light compression, such as a bandage, can offer support and minimize swelling, while elevating the hand above heart level is beneficial for reducing fluid accumulation. Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain. Gently immobilizing the hand, perhaps with a makeshift splint, can prevent further injury.
Professional Medical Assessment and Non-Surgical Treatment
A medical assessment will be conducted to confirm the injury. A healthcare provider will perform a physical examination of the hand, checking for pain, swelling, tenderness, and any visible deformity. They will also inquire about how the injury occurred and your medical history.
X-rays are crucial for confirming the diagnosis, pinpointing the fracture’s exact location, and assessing its severity and determining the degree of angulation or displacement. In some cases, a CT scan may be used for a more detailed 3D view, especially if surgery is being considered. This imaging helps differentiate a boxer’s fracture from other hand injuries.
Many boxer’s fractures can be treated non-surgically, especially if the bone is not significantly displaced or angled. If the bone is misaligned, a doctor might perform a closed reduction, which involves manually realigning the bone fragments without an incision. This procedure often involves local anesthetic, sedatives, or general anesthesia to minimize discomfort. The “90-90 method” is a common technique used for reduction, where the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints are flexed to 90 degrees to aid in realignment.
Following reduction, immobilization is essential for bone healing. This typically involves wearing a cast or a splint, such as an ulnar gutter splint, which positions the hand and fingers to prevent movement. The immobilization period usually lasts for three to six weeks, though it can vary based on the fracture’s severity. Throughout this period, continued pain management with medication and elevation helps control symptoms. Regular follow-up appointments, often with repeat X-rays, are necessary to monitor the healing process and ensure proper alignment.
Surgical Options and Rehabilitation
While non-surgical methods are common, surgery may be necessary for certain boxer’s fractures. Indications for surgical intervention include severe angulation (often greater than 30 degrees for the fifth metacarpal), significant rotational deformity where the finger crosses over another when making a fist, or open fractures. Multiple fractures or damage to surrounding tissues like ligaments, tendons, nerves, or blood vessels also warrant surgical consideration.
Surgical procedures aim to stabilize the fracture using various techniques. Common methods include percutaneous pinning, where small wires (K-wires) are inserted through the skin to hold the bone fragments in place, or open reduction internal fixation, which involves an incision to realign the bone and secure it with plates or screws. After surgery, immediate care focuses on wound management, pain control, and initial immobilization.
Rehabilitation is a critical phase for both non-surgical and surgical cases, beginning once the initial immobilization period is complete and the bone shows signs of healing. Hand therapy, often guided by a physical or occupational therapist, plays a significant role in restoring function and preventing stiffness. Early mobilization through gentle range of motion exercises is often encouraged to prevent joint stiffness and promote tendon gliding. Rehabilitation exercises typically progress from passive and active range of motion activities, such as bending and straightening the fingers, to strengthening exercises. Examples include making hook fists, full fists, and using tools like pencils or therapeutic putty to improve grip strength and finger dexterity. Adherence to the prescribed therapy program is important for optimal recovery, helping to reduce swelling, improve flexibility, and regain strength for a full return to daily activities.