Boxer's fracture: Difference between revisions
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==Background== | ==Background== | ||
*Fracture of the | *Fracture of the 4th or 5th metacarpal caused by an axial load, typically from punching a person or object | ||
==Clinical Features== | ==Clinical Features== | ||
*Pain or swelling along the | *Pain or swelling along the 4th or 5th metacarpals | ||
*Volar angulation of metacarpal or "missing 4th/5th knuckle" | *Volar angulation of metacarpal or "missing 4th/5th knuckle" | ||
* | *Look for areas of skin breakdown which may signify a fight bite that can result in a [[closed fist infection]] if untreated | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
[[File:Neck Fracture of the Fourth Metacarpal Bone.png|thumb|Boxer's Fracture]] | [[File:Neck Fracture of the Fourth Metacarpal Bone.png|thumb|Boxer's Fracture]] | ||
*AP and lateral hand | *AP and lateral hand xray | ||
==Management== | ==Management== | ||
*Indications for reduction are contingent upon angulation and rotation | *Indications for reduction are contingent upon angulation and rotation | ||
**Any rotational deformity should be reduced to allow proper hand function (seen as scissoring) | |||
**Any rotational deformity should be | **Angulation >30° in the 4th digit or >40° in the 5th digit should be reduced | ||
** | *Splinting | ||
**Classically the [[Ulnar Gutter Splint]] has been recommended | |||
**[[Forearm volar splint]] with extension over the head of the MCP joint provides equal effect and is better tolerated<ref>Hofmeister EP, Kim J, and Shin AY. Comparison of 2 Methods of Immobilization of Fifth Metacarpal Neck Fractures: A Prospective Randomized Study. The Journal of Hand Surgery. 2008; 33(8):1362–1368.</ref> | |||
==See Also== | ==See Also== | ||
Revision as of 00:49, 30 December 2015
Background
- Fracture of the 4th or 5th metacarpal caused by an axial load, typically from punching a person or object
Clinical Features
- Pain or swelling along the 4th or 5th metacarpals
- Volar angulation of metacarpal or "missing 4th/5th knuckle"
- Look for areas of skin breakdown which may signify a fight bite that can result in a closed fist infection if untreated
Differential Diagnosis
Hand and Finger Fracture Types
Diagnosis
- AP and lateral hand xray
Management
- Indications for reduction are contingent upon angulation and rotation
- Any rotational deformity should be reduced to allow proper hand function (seen as scissoring)
- Angulation >30° in the 4th digit or >40° in the 5th digit should be reduced
- Splinting
- Classically the Ulnar Gutter Splint has been recommended
- Forearm volar splint with extension over the head of the MCP joint provides equal effect and is better tolerated[1]
See Also
References
- ↑ Hofmeister EP, Kim J, and Shin AY. Comparison of 2 Methods of Immobilization of Fifth Metacarpal Neck Fractures: A Prospective Randomized Study. The Journal of Hand Surgery. 2008; 33(8):1362–1368.