A boxer’s fracture is a break (fracture) in one of the metacarpal bones of the hand. As these forms form knuckles, it is easy to imagine how they could break while boxing or punching hard surfaces with a closed fist. The fifth metacarpal (pinky finger) is most commonly injured, followed by the fourth metacarpal (ring finger). Most fractures are in the neck, or top, of the metacarpal bone near the knuckle.
It typically presents with a crack or pop sound at the time of injury. There will be pain around the fracture site, along with swelling, bruising, or discoloration. The knuckle may appear disfigured and flat if the break is severe.
The diagnosis is based on clinical history and examination. The injured hand will be examined for deformity, tenderness, swelling, and discoloration. The local neurological exam is also performed to look for evidence for nerve damage. X-rays are obtained to diagnose the fracture.
The treatment begins with ice and elevation of the hand to lessen the swelling. Anti-inflammatory medication can also help with pain and swelling. Most such fractures will require immobilization in a cast or splint for 3-6 weeks. However, If there is a break in the skin at the time of the injury, then there is a high risk of infection and antibiotics should be prescribed. A careful surgical assessment is a need for open, complex, or displaced fractures. Physical therapy may be recommended to help regain full use of one’s hand. Surgery is also used for people who use their hands for minute motor skills, such as playing the piano or performing dentistry.
The best way to prevent a boxer’s fracture during boxing is to learn proper punching technique so that the initial contact is not with the fourth and fifth knuckles. Wrapping the hands or using boxing gloves to protect from injury when training is also important in order to prevent this type of injury.
Recovery time varies based on the severity of the fracture and the extent of ensuring treatment. If it was a simple fracture then the recovery may only last two to three weeks. But if surgery or physical therapy is required, then the recovery time may prolong up to four to six weeks or even longer.
It is important to keep to closely follow the doctor’s treatment plan, which includes keeping the splint on for the designated amount of time. It is equally important to follow the physical therapy regimen and perform all at-home exercises daily. Also, protect the injured hand while it heals. Recovery is faster if one eats a healthy diet rich in protein, calcium, and vitamin D. It is critically important to not use the injured hand until the doctor says it’s safe to do so. Stop smoking as it impairs tissue healing.
If the boxer’s fracture is diagnosed accurately and treated promptly, with the patient following the medical advice carefully, there are normally no long-term effects and full recovery is achieved in most cases.