Treatment for a boxer’s fracture depends on many factors, including whether the fractured bone punctures the skin. Treatment often involves a splint or cast to immobilize the finger. In more severe cases, surgery may be necessary.
This article explores fifth metacarpal fractures, including symptoms, home care steps, and diagnosis. It also discusses treatment options and when a boxer’s fracture may require surgery.
A boxer’s fracture is the common name for a break in the fifth metacarpal bone. This is a bone in the pinky finger. It accounts for 10% of all hand fractures.
Specifically, it is a fracture of the neck of the bone that connects the finger to the wrist. The bone’s neck refers to the shaft that widens outwards towards the knuckle.
People typically have five metacarpal bones in each hand. The first refers to the bone that connects with the thumb. The fifth refers to the bone that connects to the pinky finger.
A boxer’s fracture gets its name because it is common in boxers with less experience. However, this type of break can occur with any hard strike of the hand against a solid surface.
According to the American Society for Surgery of the Hand, symptoms that may indicate a boxer’s fracture include:
- pain
- swelling
- hand or finger that is misshapen
- pinky finger crossing over to the ring finger
- difficulty straightening or moving the pinky finger
- limited range of motion between the pinky and ring fingers
If you have symptoms of a boxer’s fracture, contact a doctor for a prompt evaluation. This is particularly important if you have a puncture to the skin. Early treatment can help prevent worsening damage or other complications, such as infection.
A boxer’s fracture typically happens when punching a solid object at high speed. This can include contact with a wall or a heavy punching bag.
It can also occur if you break a hard fall on your closed knuckles or strike your hand with force against a firm object.
The area of the fifth metacarpal bone near the knuckle, or the neck, is its weakest point. This makes it most vulnerable to fracture.
Treatment for a boxer’s fracture depends on its severity. Your doctor will take several factors into consideration. These can include whether the bone has punctured the skin and any changes to the position of the bone.
Initial home treatment
For less severe boxer’s fractures, the first few days of treatment may include:
- resting your hand
- keeping your hand above heart level
- applying ice multiple times a day
- taking pain medication, either over the counter or prescribed by your doctor
Medical treatment
Depending on the severity of your boxer’s fracture, your doctor may also recommend:
- medical irrigation of any cuts or punctures in the skin
- a tetanus shot if you have a skin break and are due for an updated vaccination
- antibiotics to treat any possible infection
- a splint or cast for 3–6 weeks
- physical therapy to strengthen and stretch your hand muscles
Surgery
Surgery may be necessary to treat severe boxer’s fractures. Factors that may require surgery include:
- bone that has punctured the skin
- bone that is broken in multiple places
- injury to the nerves or blood vessels
- bone that has healed out of alignment
- bone that has significantly changed position from its normal structure
Your doctor also may recommend surgery if you perform activities that require fine-motor movement of your hand. This may include some occupations or hobbies such as working with jewelry or playing the piano.
Surgical treatments for severe boxer’s fractures typically involve pins or rods to hold bones together. This allows for stability while they heal.
Talk with your surgeon about the benefits and risks of different treatment options. They can help you determine which is right for you.
Boxer's fracture x-ray
To properly diagnose a boxer’s fracture, your doctor will perform both a physical examination and imaging tests.
First, a doctor will ask you about the injury, how it happened, and how you feel. During the physical exam, they will likely:
- examine your hand for cuts
- evaluate your pain level by putting slight pressure on your bones
- check your hand’s strength and range of motion
- check your fingers’ alignment by asking you to make a closed fist
X-ray is the most common imaging test for a boxer’s fracture. However, a doctor may also request an ultrasound or CT scan, depending on the break.
Delaying treatment of a boxer’s fracture can increase the risk of complications, which may include:
- reduced ability to grip
- limited range of motion of your pinky finger
- misaligned or misshapen finger
You may also have multiple or additional fractures in nearby bones. These could cause additional damage if they do not heal correctly.
‘Fight bite’
Your injury may be from punching someone in the face with a bare hand. If this is the case, the person’s teeth could have caused cuts or scrapes on your skin. This additional injury, known as “fight bite,” may increase your risk of infection.
Here are some other questions people often ask about boxer’s fracture. Angela M. Bell, M.D., FACP, has reviewed the answers.
Can a boxer’s fracture heal on its own?
A less severe boxer’s fracture may heal on its own. However, you may be at risk for complications, such as an inability to grip or move your fingers. Your bones may also be misaligned during healing, which can reduce range of motion in your hand.
If you think you may have a boxer’s fracture, contact a doctor for a prompt evaluation. They can recommend the most effective treatment and help you avoid possible complications.
How long does it take to recover from a boxer’s fracture?
The severity of your boxer’s fracture will determine how long it takes to heal. A simple fracture may only take a few weeks to heal. More complicated fractures may require surgery and several months to recover.
Your doctor can advise you about healing time needed for your specific injury.
Does a boxer’s fracture need surgery?
A simple boxer’s fracture usually does not need surgery. However, in severe cases, surgery may be necessary. This includes fractures that involve bone puncturing the skin, multiple fractures, or a significant shift in the bone’s alignment.
A boxer’s fracture refers to a break in the upper part of the fifth metacarpal bone. This bone connects the wrist to the base of the pinky finger. The primary symptoms include pain, swelling, and reduced movement.
Less severe boxer’s fractures may heal with a splint or cast to keep the injured bone stable. More complicated fractures may require surgery to realign the bone and treat additional hand injuries.
Seeking prompt medical care for a boxer’s fractures can help prevent possible complications, such as infection.
