Boxer's Fracture

Boxer's Fracture Overview

A boxer's fracture is defined as a break through the bones of the hand that form the knuckles. Some doctors use the term "brawler's fracture" rather than "boxer's fracture" because a boxer is not likely to get this injury. The less well-trained brawlers have to learn how to punch without hurting themselves.

The metacarpal bones in the hand connect the bones in the finger to the bones in the wrist. There are 5 metacarpal bones-1 to connect each finger to the wrist. All of the metacarpal bones have the same anatomic structure. Each consists of the base, the shaft, the neck, and the head. The base of the metacarpal bone is the portion that attaches to the bones of the wrist. The shaft is the long, slender portion of the bone. The neck is the portion of the bone that connects the shaft to the head. The head of the metacarpal bone connects the metacarpal bone to the bone of the finger. The head of the metacarpal bones form the knuckle of an enclosed fist. A boxer's fracture involves a break in the neck of the metacarpal. This was described originally in the fracture of the metacarpal bone of the little (small) finger because this is the most common one to break when punching an immovable object.

Boxer's fractures occur in the metacarpal bones that connect the ring finger or the little finger to the wrist. These are known as the fourth and fifth metacarpal bones. Some doctors include breaks in the neck of the second and third metacarpal bones in the definition of a boxer's fracture. The second metacarpal bone connects the index finger to the wrist, and the third metacarpal connects the middle finger to the wrist.

Boxer's Fracture Causes

Boxer's fractures received their name from one of their most common causes-punching an object with a closed fist. This occurs commonly during fist fights or from punching a hard object such as a wall or filing cabinet. Although these breaks usually occur when the hand is closed into a fist, they can also occur when the hand is not clenched and strikes a hard object.

Boxer's Fracture Symptoms

The typical symptoms of a boxer's fracture are pain or tenderness centered in a specific location on the hand corresponding to one of the metacarpal bones, around the knuckle. You may also note pain with movement of your hand or fingers.

• When a bone is broken, you may experience a snapping or popping sensation in the affected bone.
  
• Your hand may swell, discolor, or bruise around the injury site. Deformity of the broken bone or the knuckle, may also be noted. There may also be abnormal movement of the broken bone fragments. The doctor may be able to produce pain by pressing on the broken bone. In addition, pain can be produced by grabbing the finger that attaches to the metacarpal bone that was hurt and pushing it inward toward the broken bone.
  
• If you make a fist with the affected hand, the doctor may notice misalignment of the associated finger. The doctor may see a deformity of the broken bone. When making a fist, the finger involved may bend toward the thumb more than is usual. This is known as rotation, and, though not always seen, its presence may indicate the possibility of a more serious type of boxer's fracture.
  
• Another common sign of a possible boxer's fracture is a cut on the hand. A cut in the skin associated with a boxer's fracture may indicate a more serious type of boxer's fracture.