Episode 158.0 – Boxer’s Fracture

Boxer's Fracture

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Show Notes Background: 40% of all hand fractures A metacarpal fracture can occur at any point along the bone (head, neck, shaft, or base) The ones at the neck are what we call “Boxer’s” fractures Most common mechanism for these is a direct axial load with a clenched fist Most common metacarpal injured is the 5th A majority of these injuries are isolated injuries, closed and stable Examination: Ensure that this is an isolated injury May note a loss of knuckle contour or shortening A thorough evaluation of the skin is important Patients may also have fight bites and require irrigation and antibiotics Tender along the dorsum of the affected metacarpal Evaluate the range of motion as the commonly seen shortening results in extension lag For every 2mm of shortening there is going to be a 7 degree decrease in ability to extend the joint Check rotational alignment of digits with the MCP and PIP at 50% flexion. Partially clench their fist and ensure that the axis of each digit converges near the scaphoid pole / mid wrist Deformity is often seen due to the imbalance of volar and dorsal forces Dorsal angulation AP, lateral and oblique views should be obtained on XR The degree of angulation is estimated with the lateral view NB: Normal angle between the metacarpal head and neck is 15 degrees Management: Most may be splinted with an ulnar gutter splint Must be closed, not significantly angulated, and not malrotated When splinting, place the wrist in slight extension, MCP (knuckles) at 90 degrees and the DIP and PIP in a relaxed, slightly flexed position