Boxer's Fracture

Boxer's Fracture Overview

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" 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 five metacarpal bones, one 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 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. The person may also note pain with movement of the hand or fingers.

  • When a bone is broken, a snapping or popping sensation in the affected bone may be experienced.
  • The hand may swell, discolor, or bruise around the injury site. Deformity of the broken bone or the knuckle, also may 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 a fist is made 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.

When to Seek Medical Care

Any time a person has an injury and a fracture is suspected, contact a doctor for instructions. If a doctor is unavailable, go to the emergency department for evaluation. Contact a doctor or go to the emergency department if the affected individual's hand or arm has been splinted or casted and they develop increasing pain, numbness, or tingling in the fingers on the casted or splinted arm. Any signs of infection from a cut or sutured wound also require evaluation by a doctor.

Any hand injury that has signs or symptoms suggesting a fracture should be evaluated by a doctor. This may be accomplished by contacting a doctor. If the affected individual cannot see a doctor immediately, go to a hospital's emergency department.

Boxer's Fracture Diagnosis

Physical examination in conjunction with X-rays is essential to properly diagnose a boxer's fracture. Findings that suggest the need for X-rays include activities that increase the risk of fracture, deformity of the hand, localized tenderness, swelling of the hand, discoloration, decreased ability to move the hand, wrist or fingers, numbness, unequal temperatures between the injured and uninjured hands, or a cut caused by teeth when punching someone in the mouth (resulting in a human bite injury).

The doctor will determine if X-rays are warranted based on the circumstances surrounding the injury. After the doctor obtains detailed information about how the hand was injured, a physical examination is the next step in the evaluation.

  • Swelling and discoloration commonly are seen with fractures and are associated with damage caused by direct trauma to the bone and surrounding muscles, ligaments, tendons, nerves, and blood vessels.
  • Decreased ability to move the hand in the usual directions and manner may result from the swelling or pain associated with the fracture. The doctor will ask the patient to make a fist. This helps to determine the extent of the injury, as well as the type of treatment that may be needed. This also may indicate if a ligament has been torn. Torn ligaments will not show up on standard X-rays, but they sometimes occur with fractures.

X-rays of the hand are performed to look at the hand from three different directions. Evaluating the hand from different viewpoints reduces the risk of not seeing a fracture on the X-ray. After evaluating the bones on the X-ray, the doctor can determine what type of fracture is present. In certain cases, the doctor may order more X-rays, with special views to look for hard-to-find fractures. These studies are ordered when the standard X-rays do not show a fracture and the information regarding the patient's injury or physical examination suggests the presence of a hard-to-find fracture.