Boxer's fracture

Boxer's fracture
Boxer's fracture
Classification and external resources

DP (PA) left hand x-ray showing fracture at the neck of fifth metacarpal bone.
ICD-10 S62.3
eMedicine aaem/53

A "Boxer's fracture" is the second and/or third metacarpal transverse neck fracture that is more likely to occur from a straight punch.[1] The "Boxer's" designation is suggestive of the generally well tolerated way of striking a hard object with the closed fist, with the second and third metacarpal bones absorbing most of the force.

A "Bar Room fracture" is a transverse fracture of the fourth and/or fifth metacarpal neck.[2] The "Bar Room" designation is suggestive of an inexperienced and/or intoxicated fighter that throws a "round house" type punch,[clarification needed Please explain "round house" term.] with the fourth and fifth metacarpal bones absorbing most of the force.[3] This is generally accepted to be an unfavorable way of landing a punch.

Most recently the terms "Boxer's" and "Bar Room" are used interchangeably to refer the second and third, and the fourth and fifth metacarpal fractures.

Contents

Causes

An annotated boxer's fracture X-Ray

It is usually caused by the impact of a clenched fist with a skull or a hard, immovable object, such as a wall. The knuckle of the index finger tends to lead the rest of the knuckles in a hard punch, and the knuckle compresses and snaps the neck of the metacarpal bone.

Treatment

A conservative approach to healing can be attempted for cases with only minor angulation. Initial reduction is optimally performed by the Jahss maneuver, in which the metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP) are flexed to 90 degrees, causing reduction by tightening of the collateral ligaments of the MCP.[4] Subsequent splinting is performed with the MCP joint remaining flexed to avoid tendon contracture.[4]

Severe angulation requires pins to be put in place and realignment as well as the usual splinting. However, the prognosis on these fractures is generally good, with total healing time not exceeding 12 weeks. The first two weeks will show significantly reduced overall swelling with improvement in clenching ability showing up first. Ability to extend the fingers in all directions appears to improve more slowly. Hard casts are rarely required and soft casts or splints can be removed for brief periods of time to allow for activities such as showers and "airing out" the cast or splinted area so as to avoid skin rotting and permit cleansing of the cast or splinted area. Pain from this injury is generally very mild and rarely requires medications beyond over the counter drugs such as ibuprofen or acetaminophen. Muscle atrophy in isolated areas of 5 to 15 percent should be expected with a rehabilitation period of approximately 4 months given adequate therapy. In the mildest of cases, full rehabilitation status can be achieved within 3 to 4 months.

For smaller angled fractures most discomfort is alleviated by raising the fracture above the heart; after swelling has subsided, if there is no cast, warm water can be used to relieve some of the pain. It is important that when the cast is removed that the hand is gently exercised by attempting the common functions in the hand.

Prevention

Boxers and other combat athletes routinely use hand wraps and boxing gloves to help stabilize the hand, greatly reducing pain and risk of injury during impact training such as working the heavy bag. Hand wraps are made with typical athletic tape.

References

  1. ^ Essentials of Skeletal Radiology (3rd. Ed.), page916.
  2. ^ Essentials of Skeletal Radiology (3rd. Ed.), page916.
  3. ^ Essentials of Skeletal Radiology (3rd. Ed.), page916.
  4. ^ a b Page 42 in: Weinzweig, Jeffrey (1999). Hand & Wrist Surgery Secrets (The Secrets Series). Philadelphia: Hanley & Belfus. ISBN 1-56053-364-1. 

External links


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