What is a Boxer’s fracture?? Fracture of the 4th or 5th metacarpal neck

 - Common in younger males

 - Usually secondary to the following injuries: punching a wall, direct blunt/force trauma, falls onto the hand

Symptoms/exam findings concerning for Boxer’s fracture?

 - Pain along ulnar aspect of the hand

 - Swelling along dorsum or ulnar part of hand

 - Focal tenderness or step off over fractured metacarpal

 - Always check for skin integrity, intact strength/sensation, and pulses!!

 - Don’t miss – compartment syndrome!

Management:

 - Immobilize with ulnar gutter splint – usually for 4 weeks

Urgent orthopedics referral:

 - Neurovascular compromise

 - Certain radiologic findings:

   - Comminuted

   - Displaced or evidence of malrotation

   - Compromise of growth plate or articular space

   - Multiple fractures

   - Overlying wounds or signs of open fracture

Hand consult recommended if injury of dominant hand or occupation/hobbies significantly affected!



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