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Boxers break12/4/2023 ![]() ![]() ![]() The fifth metacarpal neck can tolerate angulation of up to 50-60 degrees and management may be continued non-operatively if remains within the acceptable tolerances. The injury should be immobilized with an ulnar gutter splint, and post-reduction films should be taken to assess for adequate reduction. ![]() The clinician should be able to feel the reduction when it has been achieved. This axial pressure to the PIP applies dorsal force to the distal fracture fragment. The clinician should then apply volar pressure over the dorsal aspect of the fracture site while applying pressure axially to the flexed PIP joint. Younger children or very anxious patients may require procedural sedation, but this procedure typically is tolerated well without sedation.Ĭlosed reduction of a Boxer’s fracture is accomplished by using the “90-90 method.” The MCP, DIP, and PIP joints should all be flexed to 90 degrees. Flexion of these joints is important to prevent shortening of the collateral ligaments and subsequent loss of range of motion and functional impairment.Ĭlosed reduction is required for a Boxer’s fracture with significant angulation greater than 30 degrees.Īnalgesia options for the procedure include a hematoma block or an ulnar nerve block. The hand should be positioned in the intrinsic plus position for splinting: mild wrist extension, 70 to 90 degrees of flexion at MCP joint, and slight flexion at the DIP and PIP joints. Alternatively, a pre-made Galveston splint or a custom orthosis may be used. A Boxer’s fracture should be immobilized with an ulnar gutter splint. Due to the risk of infection from "fight bite," even very small wounds should be thoroughly irrigated, and there should be a low threshold for antibiotic treatment.įor a Boxer’s fracture that is closed, not angulated, and not malrotated or otherwise displaced, splinting is used for initial immobilization. ![]() The appropriate treatment for a Boxer’s fracture on initial presentation varies based on whether the fracture is open or closed, the degree of angulation, rotation, and other concomitant injuries. The arteries and nerves supplying the fingers are adjacent to the metacarpal bones and can be injured in severely displaced Boxer’s fractures, requiring surgical intervention. The ligaments are taut in flexion, and more slack in extension, therefore the MCP joints should be splinted in flexion to prevent shortening (intrinsic plus positioning). The collateral ligaments also join the metacarpal bones to the proximal phalanges and must be taken into consideration during splinting to minimize the risk of loss of motion due to shortening of the ligaments. The interosseous muscles, responsible for adduction and abduction of the fingers, originate from the metacarpal shafts and insert onto proximal phalanges. Axial load via direct trauma to a clenched fist transfers energy to the metacarpal bone, causing fractures most commonly at the neck, and typically resulting in apex dorsal angulation due in part to the forces exerted by the pull of the interosseous muscles. The metacarpal bone consists of a head (distally located), neck, body, and base (proximally located). The fifth metacarpal is associated with the fifth digit. The fifth metacarpal bone is one of the five metacarpal bones of the hand. ![]()
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