Boxer's fracture
Background
- Fracture of the fourth or fifth metacarpal bones caused by an axial load, typically from punching a person or object.
Clinical Features
- Pain or swelling along the fourth or fifth metacarpals
- Volar angulation of metacarpal or "missing 4th/5th knuckle"
- Always look for areas of skin breakdown, as these may signify a Fight Bite.
Imaging
- Typically seen on AP or lateral hand radiographs
Management
- Indications for reduction are contingent upon angulation and rotation.
- Any rotational deformity should be fixed to allow proper hand function.
- 10 degrees of angulation is tolerated in the 1st and 2nd metacarpals, while the third and fourth metacarpals can tolerate up to 40 degrees of angulation.