Boxer's fractures:
Boxer’s fracture, medically known as a metacarpal fracture, accounts for about 20% of all hand fractures. This fracture usually occurs in the young and active population and may have a significant impact on the functional use of your hand.
Anatomy:
The metacarpal bones are the long bones in the hand that connect the fingers to the wrist. Each hand has 5 metacarpal bones. A boxer’s fracture typically affects the neck of the fifth metacarpal, although it can occur in any of the metacarpal bones. This type of fracture usually involves a break in the bone just below the knuckle, leading to pain, swelling, and limited mobility.
Mechanism of Injury:
A boxer’s fracture commonly occurs due to a direct blow to a clenched fist, such as punching a hard surface with improper technique. The force generated during impact can exceed the bone’s strength, resulting in a fracture. Additionally, falls onto an outstretched hand or crushing injuries can also cause this type of fracture.
Risk Factors:
Several factors can increase the risk of sustaining a boxer’s fracture, including:
- Participation in contact sports like boxing or martial arts.
- Lack of protective gear during sports activities.
- Poor punching technique.
- Osteoporosis or weakened bones due to aging or medical conditions.
- Occupational hazards involving manual labor or repetitive hand movements.
Assessment:
Diagnosing a boxer’s fracture typically involves a physical examination and imaging studies, such as X-rays. During the examination, your physiotherapist will assess for swelling, a deformity,tenderness and the hand’s range of motion. X-rays help confirm the diagnosis and determine the extent and location of the fracture.
Management:
The management of a boxer’s fracture depends on various factors, including the fracture’s severity, displacement, and overall health. Treatment options may include:
- Immobilisation: Initially, the hand may be immobilised using a splint or cast to promote healing and prevent further injury. The duration of immobilisation varies based on the fracture’s stability and healing progress. Immobilisation is typically done by an orthopaedic surgeon.
- Reduction: In cases of significant displacement or angulation, an orthopaedic surgeon may perform a closed reduction procedure to realign the fractured bone. This procedure may be done under local anesthesia, and afterward, the hand is immobilised to maintain proper alignment.
- Surgery: Severe fractures or those with multiple fragments may require surgical intervention. Surgical fixation, such as the use of pins, plates, or screws, may be necessary to stabilise the fracture and facilitate healing.
- Rehabilitation: Once the fracture begins to heal, rehabilitation exercises are essential to restore hand function, strength, and mobility. Your physiotherapist will develop a customised rehabilitation program tailored to the individual’s needs, which may include exercises, manual therapy, and functional activities.
- Pain Management: Pain management strategies, such as over-the-counter or prescription medications, may be recommended to alleviate discomfort during the healing process.
Conclusion:
A boxer’s fracture can significantly impact hand function and performance if not properly managed. Early diagnosis, appropriate treatment, and rehabilitation are essential for optimal recovery and a return to normal activities. If you’ve injured your hand, do not hesitate to book an appointment with one of our experienced physiotherapists.
References:
- Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2014.
- Malik S, Herron T, Taqi M, Rosenberg. Fifth Metacarpal Fracture
- Viegas SF, Patterson RM, Hokanson JA, Davis J. Hand injuries in boxing. The American Journal of Sports Medicine. 1988;16(2):130-134.
- Hammer M, Rüsch P, Platz A, et al. Risk Factors of Boxer’s Fractures in Professional and Amateur Boxers. International Journal of Sports Medicine. 2014;35(6):534-538.
- Rizzo M, Katt BA, Carothers JT. The use of a sugar tong splint in boxer’s fractures. The Journal of Hand Surgery. 2008;33(9):1630-1631.
