Boxer's fracture | |
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Other names | Metacarpal neck fracture of the little finger, scrapper's fracture, [1] bar room fracture, street fighter's fracture [1] |
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Boxer's fracture of the 5th metacarpal head from punching a wall | |
Specialty | Emergency medicine, orthopedics |
Symptoms | Pain, depressed knuckle [2] |
Causes | Hits an object with a closed fist [3] |
Diagnostic method | Based on symptoms and confirmed by X-rays [3] |
Treatment | Buddy taping and a tensor bandage, reduction and splinting [4] [3] |
Medication | Ibuprofen, paracetamol (acetaminophen) [3] |
Prognosis | Generally good [4] |
Frequency | 20% of hand fractures [4] |
A boxer's fracture is the break of the fifth metacarpal bone of the hand near the knuckle. [4] Occasionally, it is used to refer to fractures of the fourth metacarpal as well. [1] Symptoms include pain and a depressed knuckle. [2]
Classically, it occurs after a person hits an object with a closed fist. [3] The knuckle is then bent towards the palm of the hand. [3] Diagnosis is generally suspected based on symptoms and confirmed with X-rays. [3]
For most fractures with less than 70 degrees of angulation, buddy taping and a tensor bandage resulted in similar outcomes to reduction with splinting. [4] In those with more than 70 degrees of angulation or in which the broken finger is rotated, reduction and splinting may be recommended. [3]
They represent about a fifth of hand fractures. [4] They occur more commonly in males than females. [4] Both short and long term outcomes are generally good. [4] The knuckle, however, typically remains somewhat deformed. [5]
The symptoms are pain and tenderness in the specific location of the hand, which corresponds to the metacarpal bone around the knuckle. When a fracture occurs, there may be a snapping or popping sensation. There will be swelling of the hand along with discoloration or bruising in the affected area. Abrasions or lacerations of the hand are also likely to occur. The respective finger may be misaligned, and movement of that finger may be limited and painful.[ citation needed ]
Metacarpal fractures are usually caused by the impact of a clenched fist with a hard, immovable object, such as a skull or a wall. [6] When a punch impacts with improper form, the force occurs at an angle towards the palm, creating a dorsal bend in the bone, ultimately causing the fracture when the bone is bent too far.[ citation needed ]
When a boxer punches with proper form, the knuckles of the second and third metacarpal align linearly with the articulating radius, followed linearly by the humerus. Due to the linear articulation of bones, the force is able to travel freely across these joints and bones and be dissipated without injury. Therefore, fractures of the second or third metacarpals are rare, with fractures of the 4th and 5th metacarpals comprising the vast majority of metacarpal fractures. [7]
Diagnosis by a doctor's examination is the most common, often confirmed by x-rays. X-ray is used to display the fracture and the angulations of the fracture. A CT scan may be done in very rare cases to provide a more detailed picture.[ citation needed ]
Boxers and other combat athletes routinely use hand wraps and boxing gloves to help stabilize the hand, greatly reducing pain and risk of injury during impact. Proper punching form is the most important factor to prevent this type of fracture.[ citation needed ]
Ice is applied to relieve pain and swelling. Any open wounds are cleansed to avoid infection.[ citation needed ]
For most fractures with less than 70 degrees of angulation, buddy taping and a tensor bandage resulted in similar outcomes to reduction with splinting. [4] Conservative treatment with early mobilization has also been found non-inferior when compared to surgical treatment with bouquet pinning for fractures presenting with less than 45 degrees of palmar angulation. [8]
In rare cases when the fracture causes rotational deformity or severe angulation surgery may be required to place pins or plates in the bone to hold the pieces in place. [9] [10]
Prognosis for these fractures is generally good, with total healing time not exceeding 12 weeks. The first two weeks will show significantly reduced overall swelling, with improvement in clenching ability showing up first. Ability to extend the fingers in all directions appears to improve more slowly. Hard casts are rarely required, and soft casts or splints can be removed for brief periods of time to allow for cleaning and drying the skin underneath the splint. [11] Pain from injury varies person to person as with most injuries. Depending on the individual a course of over the counter or narcotic pain medication will suffice. Muscle atrophy of 5 to 15 percent may be expected, with a rehabilitation period of approximately 4 months given adequate therapy. In the mildest of cases, full rehabilitation status can be achieved within 3 to 4 months.[ citation needed ]
Hand and wrist injuries are reported to account for fifteen to twenty percent of emergency room injuries, and metacarpal fractures represent a significant number of those injuries. Hand injuries of this sort are most prevalent among fifteen- to thirty-five-year-old males, and the fifth metacarpal is the one most commonly affected. [12]
Males are nearly fifty percent more likely to sustain fracture from a punch mechanism than females. Male intentional punch injuries are correlated predominantly with social deprivation, while female punch intentional injuries show more correlation with psychiatric disorders. [13] Approximately 3.7 male hand injuries, per 1000, per year, and 1.3 female hand injuries, per 1000, per year, have been reported. Common mechanisms of injury are gender specific. Although the fiscal cost is not available, it can be asserted that the cost is reasonably significant per individual, depending on the cost of emergency care, immobilization, surgery, follow up doctors' visits, etc. in addition to the fiscal impact from loss of and/or limited work abilities.[ citation needed ]
As these are colloquial terms, texts and medical dictionaries do not universally agree on precise meanings. Various authorities state that a "boxer's fracture" means a break in specifically the second metacarpal bone or third metacarpal bone, [14] with "bar room fracture" being specific to the fourth metacarpal bone or fifth metacarpal bone. [15] This is derived from boxers properly punching through the 2nd and 3rd knuckles, whereas inexperienced fighters often connect with the weaker 4th and 5th. Though some writers assert that boxer's fracture and bar room fracture are distinct terms representing injuries to different bones, this distinction seems to have been lost and most medical professionals now describe any metacarpal fracture as a "boxer's fracture".[ citation needed ]
A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.
A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The ulna bone may also be broken.
A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle. Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. Complications can include a collection of air in the pleural space surrounding the lung (pneumothorax), injury to the nerves or blood vessels in the area, and an unpleasant appearance.
Splints is an ailment of the horse or pony, characterized by a hard, bony swelling, usually on the inside of a front leg, lying between the splint and cannon bone or on the splint bone itself. It may be "hot," meaning that it occurred recently and is still painful; or "cold," meaning that the splint has completely recovered and there is no longer any swelling or pain associated with it. Bucked shins are sometimes called 'shin splints,' which involve small stress fractures of the dorsal cannon bone, often seen in race training, and discussed elsewhere.
A traction splint most commonly refers to a splinting device that uses straps attaching over the pelvis or hip as an anchor, a metal rod(s) to mimic normal bone stability and limb length, and a mechanical device to apply traction to the limb.
A mallet finger, also known as hammer finger or PLF finger or Hannan finger, is an extensor tendon injury at the farthest away finger joint. This results in the inability to extend the finger tip without pushing it. There is generally pain and bruising at the back side of the farthest away finger joint.
A hand wrap or wrist wrap is a strip of cloth used by boxers to protect the hand and wrist against injuries induced by punching. It is wrapped securely around the wrist, the palm, and the base of the thumb, where it serves to both maintain the alignment of the joints, and to compress and lend strength to the soft tissues of the hand during the impact of a punch.
A scaphoid fracture is a break of the scaphoid bone in the wrist. Symptoms generally includes pain at the base of the thumb which is worse with use of the hand. The anatomic snuffbox is generally tender and swelling may occur. Complications may include nonunion of the fracture, avascular necrosis of the proximal part of the bone, and arthritis.
Jammed finger is a colloquialism referring to a variety of injuries to the joints of the fingers, resulting from axial loading beyond that which the ligaments can withstand. Common parts of the finger susceptible to this type of injury are ligaments, joints, and bones. The severity of the damage to the finger increases with the magnitude of the force exerted by the external object on the fingertip. Toes may become jammed as well, with similar results.
Bennett fracture is a type of partial broken finger involving the base of the thumb, and extends into the carpometacarpal (CMC) joint.
A nasal fracture, commonly referred to as a broken nose, is a fracture of one of the bones of the nose. Symptoms may include bleeding, swelling, bruising, and an inability to breathe through the nose. They may be complicated by other facial fractures or a septal hematoma.
The hand is a very complex organ with multiple joints, different types of ligament, tendons and nerves. Hand disease injuries are common in society and can result from excessive use, degenerative disorders or trauma.
Dislocations occur when two bones that originally met at the joint detach. Dislocations should not be confused with subluxation. Subluxation is when the joint is still partially attached to the bone.
A femoral fracture is a bone fracture that involves the femur. They are typically sustained in high-impact trauma, such as car crashes, due to the large amount of force needed to break the bone. Fractures of the diaphysis, or middle of the femur, are managed differently from those at the head, neck, and trochanter; those are conventionally called hip fractures. Thus, mentions of femoral fracture in medicine usually refer implicitly to femoral fractures at the shaft or distally.
A fist is the shape of a hand when the fingers are bent inward against the palm and held there tightly. To make or clench a fist is to fold the fingers tightly into the center of the palm and then to clamp the thumb over the middle phalanges; in contrast to this "closed" fist, one keeps the fist "open" by holding the thumb against the side of the index finger. One uses the closed fist to punch the lower phalanges against a surface, or to pound with the little-finger side of the hand's heel; one uses the open fist to knock with the middle knuckle of the middle finger.
Tibia shaft fracture is a fracture of the proximal (upper) third of the tibia. Due to the location of the tibia, it is frequently injured. Thus it is the most commonly fractured long bone in the body.
Dieterich's disease, also known as avascular necrosis of the metacarpal head, is an extremely rare condition characterized by temporary or permanent loss of blood supply to the metacarpal head of the metacarpal bone, resulting in loss of bone tissue. The five metacarpal bones are long bones located between the carpals of the wrist and phalanges of the fingers. Collectively, the metacarpals are referred to as the "metacarpus."
A Torus fracture, also known as a buckle fracture is the most common fracture in children. It is a common occurrence following a fall, as the wrist absorbs most of the impact and compresses the bony cortex on one side and remains intact on the other, creating a bulging effect. As the bulge is only on one side of the bone, this injury can be classified as an incomplete fracture. The compressive force is provided by the trabeculae and is longitudinal to the axis of the long bone, meaning that the fracture itself is orthogonal to that axis. The word "torus" originates from the Latin word "protuberance."
A medial epicondyle fracture is an avulsion injury to the medial epicondyle of the humerus; the prominence of bone on the inside of the elbow. Medial epicondyle fractures account for 10% elbow fractures in children. 25% of injuries are associated with a dislocation of the elbow.
A broken finger or finger fracture is a common type of bone fracture, affecting a finger. Symptoms may include pain, swelling, tenderness, bruising, deformity and reduced ability to move the finger. Although most finger fractures are easy to treat, failing to deal with a fracture appropriately may result in long-term pain and disability.