What is the treatment for a boxer's fracture?

Treatment of Boxer's Fracture

For most boxer's fractures with volar angulation up to 70 degrees, functional treatment with a pressure bandage for one week followed by immediate mobilization is sufficient and produces good outcomes. 1

What is a Boxer's Fracture?

• A boxer's fracture is a fracture of the distal fifth metacarpal (and sometimes fourth metacarpal) neck, commonly resulting from punching an object with a closed fist 2
• The injury earned its name from the mechanism of injury - punching an immovable object without protection 2

Assessment and Diagnosis

• Look for obvious deformity, swelling, or bruising of the hand; severe pain with movement; or inability to move the affected digit 3
• Radiographic evaluation is necessary to determine the degree of angulation and displacement

Treatment Algorithm

Conservative Management (First-Line)

For uncomplicated boxer's fractures with angulation ≤70 degrees without rotation:

1. Functional treatment:

   • Pressure bandage for 1 week followed by immediate mobilization within pain limits 1
   • No reduction necessary for fractures with angulation less than 70 degrees 1, 4

2. Alternative conservative option:

   • Ulnar gutter splint for immobilization 5
   • However, studies show that splint immobilization is not necessary for most boxer's fractures 4

Surgical Management

For boxer's fractures with:

• Angulation >70 degrees
• Rotational deformity
• Open fractures
• Multiple fractures

Consider:

• Closed reduction and percutaneous pinning
• Open reduction and internal fixation

Expected Outcomes

• Most patients with uncomplicated boxer's fractures (≤50° angulation) treated conservatively:
  • Return to work immediately
  • Have good functional outcomes 6
  • Achieve satisfactory range of motion of the fifth metacarpophalangeal joint 1

Rehabilitation

• An appropriate rehabilitation program should include:
  • Early post-fracture introduction of physical training
  • Muscle strengthening
  • Long-term continuation of hand exercises 3

Common Pitfalls and Caveats

• Unnecessary reduction of fractures with angulation less than 70 degrees does not improve range of motion outcomes 1
• Overtreatment with prolonged immobilization may lead to unnecessary stiffness and delayed return to function 4
• If a fracture is associated with an open wound and severe bleeding, follow first aid for severe external bleeding 3
• If a fractured extremity appears blue, purple, or pale, seek emergency medical care immediately as this may indicate poor perfusion 3

Patient Education

• Patients should be educated about:
  • Expected recovery timeline
  • Pain management strategies
  • Signs of complications requiring medical attention
  • Rehabilitation exercises 3

Follow-up

• Clinical evaluation at 6 and 12 weeks after fracture to assess:
  • Range of motion
  • Pain levels
  • Return to work and activities
  • Need for physiotherapy 1

The evidence strongly supports that immediate mobilization after a short period with a pressure bandage provides excellent outcomes for boxer's fractures with angulation up to 70 degrees, making this approach preferable to prolonged immobilization in most cases 1, 4.