What Is Boxer's Fracture?
A boxer's fracture is 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." Other names are metacarpal fracture, metacarpal neck fracture, hand fracture, boxing fracture, broken hand, and hand injuries.
Your hands’ metacarpal bones connect the bones in the finger to the bones in the wrist. There are five metacarpal bones -- one to connect each finger to the wrist. All of them have the same anatomic structure: Each consists of the base, the shaft, the neck, and the head. The base is the part that attaches to the bones of the wrist. The shaft is the long, slender part of the bone. The neck is the part that connects the shaft to the head. The head of the metacarpal bone connects it to the bone of the finger. The head of the metacarpal bones forms the knuckle of a closed fist.
A boxer's fracture is a break in a metacarpal bone that connects the ring finger or the little finger to the wrist. These are known as the fourth and fifth metacarpal bones. Some doctors also 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 Symptoms
The typical symptoms of a boxer's fracture are pain or tenderness on the hand near one of the metacarpal bones, around the knuckle. You may also have pain when you move your hand or fingers.
- When a bone is broken, you may have snapping or popping sensations.
- Your hand may swell, discolor, or bruise around the injury site. You may also have some deformity of the broken bone or knuckle. You may notice movement of the broken bone fragments.
- If you press on the area, you’ll feel pain. It’ll also hurt to push the finger that attaches to the metacarpal bone inward.
- When making a fist, the finger that is hurt may appear misaligned. It may bend toward the thumb more than is usual. This is known as rotation, and it can be a sign of a more serious type of boxer's fracture.
- A cut in the skin may also indicate a more serious type of boxer's fracture.
Boxer's Fracture Causes
Boxer's fractures get their name from one of their most common causes -- punching an object with a closed fist. This can happen during fist fights or from punching a hard object such as a wall or filing cabinet. Although less common, this type of fracture can also happen when the hand isn’t clenched and strikes a hard object.
Boxer’s Fracture Diagnosis
Your doctor will ask you what happened to cause the injury and they’ll do a physical exam. They’ll look for things like:
- Deformity tenderness
- Decreased ability to move the hand, wrist or fingers
- Unequal temperatures between the injured and uninjured hands
- A cut
Swelling and discoloration are common with fractures. This is because of direct trauma to the bone and surrounding muscles, ligaments, tendons, nerves, and blood vessels.
The doctor will ask you to make a fist to check your ability to move your hand. This helps determine the extent of the injury, as well as the type of treatment that may be needed. The doctor may also be able to determine if a ligament has been torn. Torn ligaments won’t show up on standard X-rays. If they think you may have a fracture, they’ll take X-rays of your hand to check.
Typically, the X-rays look at the hand from three different directions. Getting images from different angles makes it easier for the doctor to see possible fractures. They should be able to see if there’s a break and if so, tell what type it is. Sometimes, the doctor may order more X-rays, with special views to look for hard-to-find fractures.
Depending on how the injury happened, it’s possible the X-rays will show an object -- also called a foreign body -- in your hand. Foreign bodies that may show up on X-rays are glass, bone, metal, and stones. This could happen if the injury came from:
- Punching another person in the mouth
- Being bitten by an animal
- Being cut with a sharp object
- Having something go through your hand
When to seek medical care
Any time you have an injury and think you may have a fracture, contact your doctor. If the doctor is unavailable, go to an urgent care.
If you’ve already been splinted or casted and have increasing pain, numbness, or tingling in the fingers on the casted arm, call your doctor. These could be signs of infection that will need a doctor’s care.
Boxer's Fracture Treatment
Home care for boxer's fractures can be divided into care prior to seeing a doctor and care after a diagnosis of a boxer's fracture is made.
Boxer’s fracture home care before diagnosis
The immediate goals of caring for an injured hand are to minimize pain, swelling, and the risk of infection of any open cuts. You also need to prevent further injury.
- Ice and elevation: The best approach to reduce pain and swelling is to apply an ice pack to the injured area. If ice isn’t available, placing a towel soaked in cold water on the injured hand will work. Elevating the injured hand will also help reduce swelling.
- Clean and treat cuts: An open cut suggests an open fracture. This type of break is at higher risk for infection and poor healing. All cuts should be washed with soap and water and then covered with a clean bandage right away.
- Immobilize hand: This helps prevent further injury from a fracture. You can do this by holding the injured hand in the uninjured hand. Take care not to use the injured hand to lift objects or perform any task that would place stress on it. Using a broken hand in such a way can cause further damage.
Boxer’s fracture home care after diagnosis
Home care after the diagnosis of a boxer's fracture is based on how the doctor treated the hand. Home care includes pain management, cast or splint care, and monitoring for signs of infection.
- Pain management. Bones, like many other parts of the body, have nerve fibers that transmit the sensation of pain. Pain from broken bones is caused by swelling or by the broken bone moving. Once a broken bone is immobilized and you stop moving it, you should have less pain. If your doctor writes a prescription for pain medication, take the medication as prescribed. This will help alleviate pain and will minimize the risk of any unwanted side effects from the medication. For mild pain, over-the-counter acetaminophen (Tylenol) or ibuprofen (Advil) may be used as directed on the label. Talk to your doctor before you take these medicines.
- Splinting or casting. One or the other is used on all boxer's fractures that don’t need immediate surgery. All splints and casts should be kept dry in order to maintain their strength. It’s possible for the cast to become too tight from the swelling of the fracture. When this happens, you may feel pain. Another sign is numbness or tingling in the fingers on the casted hand and the finger may become cool to the touch. If this happens, call your doctor.
- Care for wounds or stitches. You can get an infection in an open cut. Wounds should be kept clean and covered until healing is complete. If you have stitches to close a cut, the doctor will give you instructions on how to care for them and when they should be removed. Follow these directions carefully to lower your chance of infection. Warning signs of infection include redness, red streaking away from the cut, warmth, or swelling around the site of the cut. Pus may also drain from the wound. Call your doctor if you have any of these signs.
Boxer’s fracture medical treatment
The primary goals of treatment are to stop the hand from moving around so it can start healing and to help with the pain.
A splint should immobilize the joints above and below the site of injury. In the case of a boxer's fracture, different types of splints may be used. One type of splint may extend from the fingers, with the fingertips exposed, to the forearm near the elbow. Another type that has been shown to be effective for some boxer's fractures of the little finger is to buddy-tape the ring finger and little finger together. Your doctor will decide what type of splint will treat your fracture the best.
- When a boxer's fracture happens, it is possible for a portion of the metacarpal bone to move out of alignment. This is called angulation. The amount of angulation will determine what type of treatment is needed to ensure proper healing. People with boxer's fractures who have acceptable amounts of angulation may be splinted in the emergency department or doctor's office.
- If there’s any degree of angulation in the second or third metacarpal bones you may need a referral to a hand specialist for possible surgical repair. Boxer's fractures of the fourth and fifth metacarpal bones only need surgery if there’s a large degree of angulation and the bones cannot be moved into the correct place by pulling and pushing on them after the hand is numbed with anesthesia.
- Because broken bones can cause significant amounts of pain, pain management is an important aspect to treating broken bones. Pain management is best accomplished with anti-inflammatory medicines and pain relievers. Acetaminophen (Tylenol) or ibuprofen (Advil) usually provides good pain relief with few side effects. These over-the-counter medications, or any prescription pain medicines, should be taken as directed to decrease the risk of side effects.
Boxer’s Fracture Recovery and Follow-Up
Your doctor may ask you to follow-up with a bone specialist (orthopedic surgeon) or a hand specialist to ensure that the broken bone mends properly. The hand specialist may be either an orthopedic surgeon or a plastic surgeon who specializes in hand injuries.
- Follow-up within 1 week of the initial injury, or sooner.
- Loosen your splint, notify your doctor, and return to the emergency department immediately if you had a plaster splint placed in your doctor's office, or in the emergency department, and you develop increased pain or numbness in your fingers, or if your fingers become cold and blue.
- Go to your physical therapy appointments if your doctor recommends it.
- Eat healthy foods that include vitamin D, calcium, and protein.
- Get your splint wet.
- Get into a fist fight or do other things that boost your chance of reinjury.
Boxer’s Fracture Prevention
The key to preventing boxer's fractures is to avoid situations in which the injury can happen.. Boxer's fractures happen most often during fist fights and when someone punches a hard object in anger or frustration.
Slowing the loss of bone that occurs naturally with age can also help avoid boxer’s fractures. You can help stave-off bone loss by getting regular exercise and getting enough calcium either through dairy products, fortified foods or supplements. Talk to your doctor about what may be best for you.
Boxer’s Fracture Outlook
With proper immobilization of the broken bones and good follow-up with a hand specialist, most people with a boxer's fracture have a good outcome. If you need surgery, you may have a longer period of recovery than someone who only needs splinting. Some will need physical therapy after the splint is removed because the muscles become weakened from not being used.
Complications of Boxer’s Fracture
Complications aren’t likely if you get treatment for boxer’s fracture. If you don’t get treatment, complications may include:
- A decrease in your ability to grip
- Limited range of motion of the finger
- An abnormal looking finger
Boxer’s fracture that is treated properly and soon after the injury happens is likely to fully recover with few long-term problems if any.