QUESTION: An 18 year old engineering student complains of pain in his hand after punching a wall. His hand is swollen and the little finger knuckle has disappeared. It hurts to write, shake hands, or use his hand for any activity requiring strong grip. He has looked up the injury online and thinks he has a ‘boxer’s fracture’. What should he do?
What Is It?
A boxer’s fracture is a fracture of the 5th metacarpal, and may result in forward angulation of the head of the metacarpal. Often the hand will be swollen and extremely painful with any attempts at making a strong grip. Shaking hands is impossible!
Boxer’s fracture is a colloquial term. As you may have guessed, the fracture usually occurs when someone strikes a hard object with a closed first causing a break transversely across the neck of the bone. Other colloquial terms include scrapper’s fracture or bar room fracture.
Common symptoms of a boxer’s fracture include:
• The knuckle ‘disappearing’
An X-Ray is required to assess the severity of the boxer’s fracture.
Most people with a boxer’s fracture will be managed by their hand therapist. They require a custom made thermoplastic splint which supports the ring and little fingers, and in most cases, the splint will leave the wrist and finger joints free to move. You will also be provided with:
- Education about appropriate care of your swollen hand
- Provision of a custom-made thermoplastic splint in the ‘position of safe immobilisation’
- Exercises to non-involved joints
- Graded strengthening exercises when appropriate
Surgical review may be required if there is any rotational deformity, multiple fragments, or when a tooth has punctured the skin. Your therapist will be happy to discuss with you and your GP whether referral to a hand surgeon is appropriate.