What is a Boxer’s Fracture?
A boxer’s fracture is a break in the neck of the fifth metacarpal bone of the hand (under the little finger) near the knuckle.
The hand consists of 3 types of bones: the carpal or wrist bones, the metacarpal or long hand bones, and the phalanx or phalanges. The metacarpals are made up of five long bones that connect the carpal and phalanxes.
Structurally, the metacarpal bones can be divided into four parts: base, trunk, neck and head. In some cases, the broken bone can protrude through the skin and is called an open fracture.
Risk Factors
A boxer’s fracture is usually caused by being punched against a hard surface when your hand is clenched into a fist.
Other risk factors include:
- Trauma
- Close contact sports.
- Falling on an outstretched arm.
- Severe flexion of the arm.
- Medical conditions that weaken your bones.
Boxer’s Fracture Symptoms
Symptoms of include:
- The little finger looks bent and misaligned.
- Tingling sensation.
- The area around the little finger feels numb and cold.
- Pain, swelling and bruising on the outside of the hand (blue).
- Limited range of motion of the hand.
- Difficulty forming a fist.
What Happens If A Boxer’s Fracture Is Untreated?
An untreated boxer’s fracture can result in an abnormal-looking finger and hand. Gradually, you may experience a decrease in grasping ability.
Diagnosing a Boxer’s Fracture
- Your doctor will evaluate your symptoms and take a medical history.
- Physical examination of the hand will be done by looking for signs such as the following.
- Cracks in the skin
- A lump under the little finger
- Deformed visible joint
- Different shape on the outside of your hand
- Imaging studies such as X-ray, MRI or CT scan will be ordered to confirm the diagnosis.
Boxer’s Fracture Treatment
Treatment of a Boxer’s fracture depends on the severity of the fracture.
Your treatment plan may include:
- Taking a combination of non-steroidal anti-inflammatory drugs (NSAIDs) and opioids to manage pain
- Avoiding activities that trigger symptoms
- Applying ice packs on a towel to the area to reduce swelling and pain
- Raising your hand above heart level
- To have tetanus vaccination if necessary
- Cast or splinting to immobilize the hands for several weeks
- Physical therapy to regain strength and mobility
Surgery may be recommended if you do not respond to conservative treatment options. Stabilization of the broken bone will be achieved by using small needles. Surgery is followed by rest, use of hand splints, and physical therapy to increase flexibility, range of motion, and strength.
Boxer’s Fracture: Frequently Asked Questions
What is a Boxer’s Fracture and which bone is affected?
A Boxer’s Fracture is a break in the neck of the fifth metacarpal bone, which is the long bone in the hand that connects the pinky finger to the wrist. It is one of the most common hand fractures.
The injury typically occurs at the “neck” of the bone, just below the knuckle. While it can theoretically happen to other metacarpals, the term “Boxer’s Fracture” specifically refers to the injury on the pinky (small finger) side of the hand.
How does a Boxer’s Fracture typically occur?
Despite the name, this injury rarely happens to professional boxers because they use proper punching techniques and hand wraps. Instead, it most commonly occurs when an untrained individual strikes a hard object (like a wall or a person’s jaw) with a closed fist.
When you punch with an incorrect technique, the force of the impact is concentrated on the fifth metacarpal rather than being distributed across the stronger second and third metacarpals, causing the bone to snap or bend.
What are the symptoms and signs of a broken knuckle?
If you suspect a Boxer’s Fracture, look for these common symptoms:
- Pain and Tenderness: Intense pain specifically centered on the pinky side of the hand.
- Swelling and Bruising: Rapid swelling around the knuckle area.
- Missing Knuckle: The knuckle of the pinky finger may appear “sunken” or flat because the bone has moved out of alignment.
- Difficulty Moving Fingers: Pain when trying to make a fist or straighten the small finger.
- Misalignment (Scissoring): When making a fist, the pinky finger may overlap the ring finger.
How long does a Boxer’s Fracture take to heal?
The healing timeline for a Boxer’s Fracture generally follows this pattern:
- Initial 3-6 Weeks: The hand is usually placed in an “Ulnar Gutter Splint” or cast to keep the bone in place while it knits back together.
- 6-10 Weeks: The bone is usually strong enough to allow for light daily activities and physical therapy.
- 3 Months: Full strength is typically restored, allowing for high-impact activities or sports.
Healing time can vary based on the severity of the break and whether surgery was required.
Does a Boxer’s Fracture require surgery?
Most Boxer’s Fractures are treated nonsurgically. If the bone is not severely displaced, a doctor may perform a “closed reduction” (manually resetting the bone) followed by immobilization in a splint.
However, surgery may be necessary if:
- The bone is severely angled or rotated.
- The fingers “scissor” (overlap) when you try to close your hand.
- The fracture is “open” (the bone broke the skin).
- The bone fragments are unstable and won’t stay in place with a splint alone.
What are the long-term effects if left untreated?
Ignoring a Boxer’s Fracture can lead to permanent hand deformity and functional issues. Potential complications include malunion (where the bone heals in the wrong position), chronic grip weakness, and early-onset arthritis in the hand joints.
In many cases, an untreated fracture results in a permanent loss of the “knuckle” appearance and a decreased ability to fully extend the small finger.
