Boxer's Fracture (5th Metacarpal Fracture)
Updated: Dec 8, 2019
Fifth Metacarpal Neck Fracture (Boxer's Fracture)
A fracture can occur anywhere along the bone, but the most frequent locations are the head, neck, shaft or base (pictured above). A metacarpal fracture can occur in a variety of ways. Examples include falling on an outstretched hand, being hit with something in the hand or striking something with the hand. A Boxer's Fracture usually occurs from punching something with a closed fist. Surgical recommendations depend upon the angle at which the fracture is positioned. It is possible to treat many of these types of fractures without surgery.
Usually, these occur with a forward bend to the bone causing a deformity over the back of the hand. Again, these fractures can be treated non-operatively, but it depends on the angulation of the fracture. An important precaution with hand fractures is to make sure there is no rotational component of the fracture, causing the fingers to cross when one makes a fist. If the rotation is missed and not repaired, an athlete may develop the inability to perform certain tasks with the hand.
Multiple studies show that non-complicated Boxer's Fractures can be treated with a soft splint or buddy tape. Studies report that even fractures of up to 70 degrees angulation can be treated without surgery. I do warn patients that there will be cosmetic deformity, but should not be a functional one. When surgery is needed, an athlete probably would have a pin placed in the hand to stabilize the fracture. However, it is possible that an athlete can be taken to surgery just to have the fracture set and no hardware placed, but that is unlikely. The added benefit of surgery in some cases, is to allow an athlete to get the hand moving sooner than if a non-surgical approach was taken. The average individual usually would be put in a cast or placed in a custom hand splint, usually made by a hand therapist. Since the fracture would be stabilized, a removable splint would allow an athlete to get started on early physical therapy. Generally return to play is in about 4-6 weeks once healing is seen on x-ray and pins can be removed.