Boxer’s Fracture

Boxer’s fracture refers to a fracture (break) of the 5th metacarpal, that is the hand bone connected to the small finger. It often happens from punching a solid object, hence its name. This injury leads to pain and swelling over the broken bone.

The vast majority of boxer’s fractures can be treated without surgery. I prefer to splint these for 3 weeks and then allow motion. It is very important that the hand is splinted in the correct position. ER splints and many other splints hold the hand in positions where significant stiffness will occur. This stiffness can be so profound that it takes a surgery to improve it, whereas the original fracture would not have required a surgery without the administered ‘treatment’. Hand surgeons will splint the hand in the correct position while the fracture heals.

Some fractures will do better with a ‘closed reduction’, where the fracture is ‘set’. This involves numbing the broken bone and moving it into a better position. The hand is then splinted for 3 weeks, as above. Fractures can only be ‘set’ during the first 5-7 days, so it is important to see a hand surgeon quickly. After that, the fractures alignment is either accepted (most common) or corrected surgically (uncommon).

Most boxer’s fractures will leave a cosmetic deformity, ie. a ‘dropped knuckle’. This means that when you make a fist the knuckle of the broken bone will be less prominent. In the vast majority of cases, this deformity is cosmetic only, and normal function will ensue.

Uncommonly, a boxer’s fracture is so angulated or rotated that surgery is required. The fracture is placed into a good position and held there with either pins or a plate. I prefer to plate most of these and then obtain early motion to regain function as quickly as possible.

Regardless of how these are treated, it may be a couple of months before pain resolves and function returns to normal. It’s a function of the individual’s healing capacity and pain tolerance.

To summarize: if your hand swells and has pain after striking a solid object, it should be evaluated by a hand specialist during the first week in order to preserve all treatment options and obtain the best result. Most boxer’s fractures don’t require surgery, and do very well with non-operative management.