What is boxer’s fracture?

Boxer’s fracture is a broken bone (fracture) at the knuckle of the smallest finger or the ring finger. The metacarpal bones connect the wrist to the fingers and make up the arch of the hand. Fracture of the metacarpal to the little finger (fifth metacarpal) most often occurs near the knuckle. This is called a boxer’s fracture and occurs when the closed fist is used to strike an object or person.

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How does boxer’s fracture occur?

• Direct blow, such as a striking blow with the fist
• Indirect stress to the hand, such as that caused by twisting or violent muscle contraction (uncommon)

What increases the risk of boxer’s fracture?

• Hitting objects with unprotected knuckle
• Participation in contact sports (football, rugby)
• Sports that require hitting (boxing, martial arts)
• History of bone or joint disease (such as osteoporosis)
• Excessive alcohol intake

What are the symptoms?

• Severe pain at the time of injury
• Pain, tenderness, swelling (especially the back of the hand) and, later, bruising of the hand
• Visible deformity if the fracture is complete and the bone fragments separate enough to distort normal body contours
• Loss of normal prominence of the knuckle at the little finger
• Numbness or paralysis from swelling in the hand, causing pressure on the blood vessels or nerves (uncommon)

How is it diagnosed?

Boxer’s fractures are diagnosed by history and examination and confirmed by X-ray.

How is boxer’s fracture treated?

Non-operative treatment

The part of the hand where this bone is broken has a lot of compensatory motion, allowing for good function without the bone being in perfect alignment (position). If the bones are in acceptable alignment, the initial treatment consists of ice and elevation of the injured hand at or above heart level to reduce swelling and medications to relieve pain. Immobilization by splinting, bandaging, casting or bracing for three or more weeks is usually recommended to protect the bones while they heal.

Operative (or Surgical) treatment

For fractures that are very displaced (out of alignment) or involve the joint and are displaced, surgery is usually recommended. Surgery usually involves placement of removable pins, screws or, occasionally, plates.