View source for Boxer's fracture

==Background==
*Fracture of the 4th or 5th metacarpal caused by an axial load, typically from punching a person or object

==Clinical Features==
*Pain or swelling along the 4th or 5th metacarpals
*Volar angulation of metacarpal or "missing 4th/5th knuckle"
*Look for areas of skin breakdown which may signify a fight bite that can result in a [[closed fist infection]] if untreated

==Differential Diagnosis==
{{Hand and finger fractures DDX}}

==Evaluation==
[[File:Neck Fracture of the Fourth Metacarpal Bone.png|thumb|Boxer's Fracture (4th metacarpal)]]
[[File:Fractured5thMetacarpalHead2018.jpg|thumb|Boxer's Fracture (5th metacarpal)]]
===Workup===
*AP and lateral hand x-ray

===Diagnosis===
*Typically on plain hand x-ray showing fracture of the 4th or 5th metacarpal


;"Uncomplicated" 
''Defined as:''
*Minimally displaced
*Closed
*Isolated injury
*Fracture angulation of <70 degrees

==Management==
{{General Fracture Management}}

===Acute Reduction===
''Contingent upon angulation and rotation''
*Any rotational deformity should be reduced to allow proper hand function (seen as scissoring)
*Angulation >30° in the 4th digit or >40° in the 5th digit should be reduced
*[https://www.youtube.com/watch?v=40irKoUJqsM Video] on how to perform reduction 

{{Metacarpal fracture goals}}

===Immobilization===
''See Diagnosis section for definition''
*Uncomplicated
**Buddy taping<ref>Pellatt, R., Fomin, I., Pienaar, C., Bindra, R., Thomas, M., Tan, E., … Keijzers, G. (2019). Is Buddy Taping as Effective as Plaster Immobilization for Adults With an Uncomplicated Neck of Fifth Metacarpal Fracture? A Randomized Controlled Trial. Annals of Emergency Medicine, 74(1), 88–97. doi: 10.1016/j.annemergmed.2019.01.032 </ref>
***Similar functional outcomes those randomized to plaster cast with earlier return to work <ref>Pellatt, R., Fomin, I., Pienaar, C., Bindra, R., Thomas, M., Tan, E., … Keijzers, G. (2019). Is Buddy Taping as Effective as Plaster Immobilization for Adults With an Uncomplicated Neck of Fifth Metacarpal Fracture? A Randomized Controlled Trial. Annals of Emergency Medicine, 74(1), 88–97. doi: 10.1016/j.annemergmed.2019.01.032 </ref>
***Similar satisfaction and pain control as those randomized to plaster casting <ref>Pellatt, R., Fomin, I., Pienaar, C., Bindra, R., Thomas, M., Tan, E., … Keijzers, G. (2019). Is Buddy Taping as Effective as Plaster Immobilization for Adults With an Uncomplicated Neck of Fifth Metacarpal Fracture? A Randomized Controlled Trial. Annals of Emergency Medicine, 74(1), 88–97. doi: 10.1016/j.annemergmed.2019.01.032 </ref>
***Shorter ER Stay <ref>Pellatt, R., Fomin, I., Pienaar, C., Bindra, R., Thomas, M., Tan, E., … Keijzers, G. (2019). Is Buddy Taping as Effective as Plaster Immobilization for Adults With an Uncomplicated Neck of Fifth Metacarpal Fracture? A Randomized Controlled Trial. Annals of Emergency Medicine, 74(1), 88–97. doi: 10.1016/j.annemergmed.2019.01.032 </ref>
*Complicated: 
**[[Forearm volar splint]] with extension over the head of the MCP joint provides equal effect and is better tolerated<ref>Hofmeister EP, Kim J, and Shin AY. Comparison of 2 Methods of Immobilization of Fifth Metacarpal Neck Fractures: A Prospective Randomized Study. The Journal of Hand Surgery. 2008; 33(8):1362–1368.</ref>
***Classically, the [[Ulnar Gutter Splint]] was recommended

==Disposition==
*Outpatient management for closed fractures that are distally neurovascularly intact

===Indications for Subsequent Out-Patient Orthopedic Surgery===
*Intra-articular fracture
*Rotational malalignment of digit
*Significantly displaced or angulated fractures (see above criteria)
*Multiple metacarpal shaft fractures 
*Loss of stability from border digit during healing process

==See Also==
*[[Non-thumb metacarpal fractures]]
*[[Hand and finger fractures]]

==References==
<references/>

[[Category:Orthopedics]]