Boxer's fracture


  • 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 Fractures


Boxer's Fracture
  • AP and lateral hand xray


  • 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

See Also


  1. 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.