A bone fragment could puncture the skin from within. The skin overlying the affected area may be broken in multiple ways. The affected finger may rotate toward the thumb when a fist is made signifying displacement. There may be snapping or popping felt when a fist is made. Range of motion in the associated finger may be decreased. Similar to hand fractures, pain, swelling, and bruising around the affected knuckle are experienced with a Boxer’s fracture. What are the symptoms of a Boxer’s Fracture? If a clenched fist is hit by an object, like a baseball bat, it may also result in this type of injury. Occasionally, a fall onto an outstretched arm with the hand clenched into a fist can cause this type of fracture. This usually occurs in a fistfight or when a person punches a wall in anger. Although this type of fracture is most common near the knuckle of the fifth, or “pinky” finger, it can occur near the knuckle of the ring, middle or index fingers as well.Ī boxer’s fracture is caused by forcefully striking an object while the hand is clenched into a fist. A boxer’s fracture is a fracture of the neck of the metacarpal bone at the end closest to the knuckle. Due to the intrinsic pull of the interosseus muscles, metacarpal neck fractures typically result in dorsal angulation of the apex of the fracture, resulting in a clinical appearance of a depressed MCP joint.The bones of the hand consist of the carpal, or wrist bones the metacarpal bones, which lie between the wrist bones and the finger bones and the phalangeal bones, which form the fingers. Evaluate for extensor mechanism injuries. Note that in this position, phalanxes should point to the scaphoid. Evaluate for possible rotational misalignment of the metacarpals by observing convergence of the finger tips with flexed MCPs and PIPs. Comparing to the uninjured hand can help highlight distorted anatomy. Physical examination should include careful inspection for possible “fight bites” given the common potential mechanism of injury. Typical symptoms include tenderness or pain focally over the distal metacarpal. First metacarpal fractures include Bennett’s fractures (fracture-dislocation of the base of the first metacarpal), and Rolandos fractures (comminuted version of Bennett’s fracture) and can also occur as a result of an axial load mechanism such as punching. Fractures to the first metacarpal are less common and are often managed operatively. The fifth metacarpal is the most commonly fractured metacarpal. The metacarpal neck is the most commonly fractured site. Studies have suggested roughly 30% of hand fractures are metacarpal fractures and they account for nearly 19% of ER fracture visits. Interestingly, despite the name, these fractures are not typically seen in experienced boxers, as boxing training aims to teach one to lead with the first and second knuckles, aligning the forces of impact into an axial load that transmits and distributes force through the larger bones and joints of the forearm and upper arm. The two most common mechanisms of injury are falls or direct blows with high axial loads (i.e. Highest incidence are in men 10-19 years followed by men 20-29 years. Boxer’s Fractures are a very common injury seen in the ED.
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