From the Research
The best course of treatment for a 37-year-old male with a suspected fifth metacarpal fracture (boxer's fracture) after punching a wall would begin with proper diagnosis through X-rays to confirm the fracture and assess displacement, as X-rays are a reliable diagnostic tool for detecting fifth metacarpal fractures, with a sensitivity of 77% and a kappa coefficient of 0.859, as reported in a study comparing the diagnostic accuracy of X-ray and computed tomography in patients with wrist injury 1.
Diagnosis and Treatment
For most uncomplicated fifth metacarpal fractures, conservative management is appropriate, including:
- Immobilization with an ulnar gutter splint for 3-4 weeks with the metacarpophalangeal joint flexed at 70-90 degrees
- Pain management with acetaminophen 650mg every 6 hours and/or ibuprofen 400-600mg every 6-8 hours as needed for pain
- Ice application for 15-20 minutes several times daily for the first 48-72 hours to reduce swelling
- Elevation of the hand above heart level when possible
Follow-up and Rehabilitation
After the initial immobilization period, a follow-up X-ray is recommended to ensure proper healing, followed by range-of-motion exercises and gradual return to activities. Physical therapy may be beneficial to restore hand function.
Surgery
Surgery is typically reserved for fractures with significant angulation (>40 degrees), rotational deformity, or multiple fractures. This conservative approach is effective because most boxer's fractures heal well without surgical intervention due to the inherent stability of the fifth metacarpal and surrounding soft tissues. The use of a wrist brace, such as the WristWidget, may also be beneficial in increasing the weight-bearing capacity of the hand, especially in patients with unstable distal radioulnar joint or traumatic lesions, as reported in a study on the increase of weight-bearing capacity of patients with lesions of the TFCC using a wrist brace 2.