A Boxer’s fracture is a fracture of the fifth metacarpal, which is the bone in the hand just before the pinky finger. A boxer’s fracture occurs between the wrist and knuckle and it is one of the most common hand fractures we see.

How did a Boxer’s fracture get its name?

Boxer’s fractures most often result from punching something or someone. Interestingly, it seldom occurs in professional or amateur boxers. Professional boxers are trained to land their punches on the index finger side of the hand, with the hand in line with the wrist to deliver maximize impact energy. This type of punch can cause problems, but generally not a Boxer’s fracture.

What kind of treatments are possible for a Boxer’s fracture?

Once x-rays diagnose a Boxer’s fracture, our physicians can evaluate your particular case for conservative or surgical management. Most Boxer’s fractures can be treated conservatively, and historically orthopedic surgeons have treated this condition with a cast. New data published in the December 2020 issue of the Journal of Hand Surgery suggests there may be a better course of treatment.

The Case for Less Immobilization in Boxer’s Fractures

Researchers in Madrid recently published a study finding that most of these injuries should probably be treated with less immobilization. They followed 72 patients after they presented to the emergency room with Boxer’s fractures that were less than 70 degrees displaced and without rotational deformity. These patients were split into two groups for treatment. The first group of patients were treated with buddy taping alone, meaning the base of the ring finger was taped to the small finger. This allowed active range of motion all the way up to and including full grip, with no reduction to improve the alignment of the bone. The second group of patients were treated with a reduction of the fracture, meaning the bones were manipulated back into alignment by a physician, and a cast was put on to immobilize the hand and wrist.

Three weeks after injury, the patients in the first group had less pain and more range of motion compared with the patients in the second group. This first group of patients also experienced a shorter recovery time, and were able to return to work about 29 days sooner than the patients in group two. Stiffness was the most common complication in both groups, but the first group only had two patients affected whereas the second group had nine.

Perhaps the most interesting finding of the study was that at the nine-week follow up appointment radiographs showed similar residual deformities between the two groups. This implies that reduction, the painful process of realigning the bones, may be largely unnecessary. If further studies support these findings future Boxer’s fracture patients could experience less pain and a faster recovery.

What about my Boxer’s fracture?

A consultation with Proliance Hand, Wrist and Elbow Physicians can help determine the best treatment for your particular injury. Every injury is different and every treatment plan is individualized to have the best outcome possible. The term Boxer’s fracture is used widely but there are subtle differences that our physicians can use to guide the best treatment plan for you. To make an appointment please contact our staff at any of our five convenient Eastside locations.

 



About the Author:

Samuel E. Galle, M.D. is a board-certified orthopedic surgeon with subspecialty fellowship training in conditions of the hand and upper extremity. He has published numerous peer-reviewed articles and surgical technique videos. He lives in Kirkland, WA with his wife, two kids and one especially spoiled Cavalier King Charles Spaniel.