What is it?
A “boxer’s fracture” is a break (fracture) in one of the metacarpal bones of the hand. These bones connect the finger bones to the wrist bones and help form the knuckles. This type of fracture most commonly occurs when a person punches a hard object with a closed fist, thus the name “boxer’s fracture.” The fifth metacarpal, or “pinky finger,” is most commonly injured, followed by the fourth, or ring finger. Most breaks are in the neck, or top, of the metacarpal bone near the knuckle.

Symptoms
A patient with a boxer’s fracture may hear a crack or pop at the time of injury. He will likely have pain around the fracture site, along with swelling, bruising, or discoloration. His knuckle may also look different or flat if the break was severe.

Sports Medicine Evaluation
A sports medicine specialist will obtain a history and carefully examine the injured hand for deformity, tenderness, swelling, and discoloration. He will also assess finger and hand sensation, along with movement, which may be decreased. X-rays may be obtained to diagnose the broken bone and determine treatment.

Sports Medicine Treatment
Initial treatment with ice and elevation of the hand can lessen the swelling. Medications can also help with pain and swelling. Most fractures will only require immobilization in a cast or splint for 3-6 weeks. If there is a cut or break in the skin at the time of the injury, the fracture is considered high-risk for infection. Antibiotics are often prescribed to decrease the risk of infection. Assessment by a surgeon may be needed. In addition, a surgeon may need to be consulted if the fracture is severely bent or displaced.

Injury Prevention
The most important way to prevent a boxer’s fracture in combat athletes is to learn proper punching technique, so initial contact is not with the fourth and fifth knuckles. These athletes also routinely wrap their hands or use boxing gloves to protect themselves from injury when training.

Return to Play
Athletes can return to sports once they are pain-free with normal hand and finger movement, and have x-ray evidence of fracture healing. Often, in contact sports, a padded removable hand splint is used to protect the injury if it does not interfere with activity, and is allowable.

AMSSM Member Authors
Sarah Kinsella, MD and Margot Putukian, MD

References
Giddins GE. The non-operative management of hand fractures. J Hand Surg Eur Vol. 2015 Jan;40(1):33-41. Epub 2014 Sep 12.

Leggit JC and Meko CJ. Acute Finger Injuries: Part II. Fractures, Dislocations, and Thumb Injuries. Am Fam Physician. 2006;73(5):827-834.