The hand consists of many small bones, muscles, and tendons that articulate and work together to allow for fine motor movements, dexterity, and strength. The metacarpals are the long bones in the hand that connect to the fingers. The head of the metacarpal bones are what makes the prominence of your knuckles when you make a fist. Metacarpal fractures commonly occur during motor vehicle accidents, falls, or other trauma. Boxer’s fractures usually occur after someone hits something or falls onto a closed fist. This type of fracture specifically involves the neck of the fifth metacarpal which attaches to the pinky finger.
Boxer’s fractures may not be specific to athletes, but many athletes experience this type of fracture. It is difficult because it affects any sport that involves use of the hand for catching, throwing, gripping, or balance. Generally, there will be swelling and pain over the pinky side of the hand. There will also be a history of trauma and you may have difficulty making a fist. Sometimes your pinky knuckle may appear less prominent than usual. If you are experiencing any of these symptoms you should be evaluated by one of our doctors.
At your initial evaluation, our doctors will carefully examine your hand and take x-rays to confirm your diagnosis. Your treatment will depend on the severity of your fracture and a variety of other factors. Fractures that are non-displaced or minimally displaced can be treated conservatively in a cast or a splint. These fractures will generally heal in about 4 weeks. Your doctor will follow up with you to ensure the fracture alignment doesn’t change and get worse during your healing process.
Fractures that are displaced may need to be treated with closed reduction and splinting. This involves manually moving the bones back into proper alignment and holding them in place with a splint. You will usually receive a local anesthetic prior to the reduction to decrease your pain. An ulnar gutter splint will often be used to ensure there is no motion at the fracture site. This splint incorporates the wrist and the ring and small finger out to the tips. These fractures are followed very closely and may need to be monitored weekly in the beginning to make sure things are staying well aligned. Your doctor will determine when you have sufficient healing and can discontinue wearing the splint. Healing depends on several factors including age, fracture type and severity, but most patients will be immobilized for about 4 weeks. Physical therapy will usually be a part of your recovery. Your hand may feel stiff and weak after the splint is removed and therapy will help you regain motion and strength.
Other displaced fractures that are unstable or in multiple pieces may need surgical intervention. Surgery may be done by placing a long screw into the canal of the metacarpal to realign the fracture or by using a plate and screw on the outside of the bone. The goal in both cases is to realign the bone and hold it in place with internal hardware. You will be placed in an ulnar gutter splint after surgery. Often, you will remove the splint early on to begin range of motion exercises to avoid stiffness. Your fracture will not be healed at this point, but motion is safe because the hardware is keeping everything aligned. You will still be unable to do anything strengthening or contact sports until the fracture is healed. Our doctors will closely monitor your progress and healing with x-rays. Physical therapy may be part of your rehabilitation to help regain your motion and strength. Generally the hardware does not need to be removed and will remain in your hand for life. In rare cases, if the hardware is bothersome it can be removed once the bone is completely healed. Your doctor will let you know when it is safe to return to play and at what point you are released to use the hand without restrictions.
A boxer’s fracture or other hand injuries can cause serious setbacks for any athlete. Our goal at Modern Orthopaedics is for you to return to your sport better than before. This may take time and patience, but we want you to experience a full recovery. We understand that each athlete and sport is unique and we will develop your treatment plans accordingly. We want to understand your goals and help you reach them. Please contact our office to have an initial evaluation for hand pain and receive superior care from our doctors and staff.
As our patient, you will have an in-depth consultation with one of our doctors. We will create an individualized treatment plan together, tailored to your problem and lifestyle. Our doctors prefer non-invasive treatments whenever possible, including physical therapy and/or injections. If your problem ultimately does require surgery, our doctors prefer the least invasive surgical techniques possible. Our goals are the same as yours: to get you back to living your best life, pain free.