A boxer’s fracture is a break in the fourth or fifth metacarpal bones of the hand, at or just below the knuckle. The metacarpal bones individually connect the wrist to the finger and thumb bones. The fourth and fifth metacarpals are linked to the ring and pinky fingers respectively. This type of break, also called a “brawler’s fracture,” often results from an improperly thrown punch. Fighting isn’t always the cause; violent acts such as hitting walls or other hard objects can also stem from extreme emotional states or psychiatric disorders.

Boxer’s fractures are surprisingly common, representing roughly 20 percent of all hand fractures. The medical outlook for this condition is generally favorable, with home care, close reduction, and immobilization sufficient to effect healing, though surgery is occasionally called for. If you sustain a boxer’s fracture, regardless of cause, you can be sure that the medical providers at Baptist Health are in your corner.

What Are the Symptoms of a Boxer’s Fracture?

There are a number of possible symptoms indicating a boxer’s fracture:

• Pain or tenderness at the injury site
• A popping or snapping sound at the time of the break
• Swelling, bruising and/or discoloration
• Cuts or abrasions
• Finger immobility or misalignment

Because the broken head of the metacarpal bone is pushed in toward the palm, your knuckle may look “sunken”. There is also a possibility that the affected finger will appear shorter than it did, even after the site has healed.

What Are the Causes of a Boxer’s Fracture?

A boxer’s fracture is typically caused by striking a hard object with a closed fist, though open-hand strikes can be damaging as well. Boxers and other martial artists avoid fractures by keeping their fist and arm bones properly aligned. Improper technique enables a preponderance of force to fall on the outer metacarpals.

Risk Factors of a Boxer’s Fracture

Anyone striking hard objects with his or her fist can receive a boxer’s fracture. However, some groups are more likely to sustain this type of injury than others. You are at higher risk for a boxer’s fracture if you:

• Are male
• Are between the ages of 15 and 35 years old
• Participate in boxing, martial arts, or other combat sports
• Have a job which requires thrusting or punching movements in close environments

How Do I Prevent a Boxer’s Fracture?

The key to preventing boxer’s fractures is staying out of situations in which they occur. Avoid fights and emotional outbursts, where losing your temper might lead to striking inanimate, or any other kinds, of objects. If you box or spar in the martial arts, learn good punching techniques and wear regulation protective gear for your hands. It’s also smart to maintain bone health, through regular exercise, dairy consumption, and mineral supplements with calcium. 

How Is a Boxer’s Fracture Diagnosed?

If you’ve recently struck your hand and are showing the symptoms of a boxer’s fracture, see your physician. His or her diagnosis will typically involve:

• Documentation of your health and medical history
• A write-up of your symptoms
• A physical examination of your wrist, hand, and fingers
• Analysis of finger misalignments, knuckle deformities, lacerations, and teeth marks (from punching another person in the mouth)
• X-ray pictures of the hand from multiple perspectives, to verify the type and position of any bone breaks

How Is a Boxer’s Fracture Treated?

There are a variety of methods for treating a boxer’s fracture, some of which can be initiated at home. These include:

• Rest
• Application of ice packs
• Use of over-the-counter medications, such as NSAIDs or acetaminophen, to control pain
• Cleaning and bandaging of cuts and lacerations
• Temporary immobilization of the injury site

Boxer’s fractures usually require medical treatment as well. Your physician may pursue:

• A closed reduction: Closed reductions are non-surgical procedures for moving bones back into alignment. Your physician will typically manipulate the bones into place and then hold them there for some period of time with an orthopedic device.
• Splints and casts: Splints and casts are the primary means of immobilizing a boxer’s fracture that’s on the mend. Also proven effective in some cases is buddy taping, or the taping together of a fractured digit with a healthy one next to it (most likely the pinky and ring fingers). Do not use buddy taping what may be a broken finger without being evaluated by a healthcare professional first. Elastic or pressure bandages are also used.
• Surgery: On occasion, surgery is required to fix a boxer’s fracture. The surgeon will realign and stabilize the injured bone or bones, using wires, screws, pins, or plates, depending on the nature and extent of the damage.

Complications

Immobilization of fractures can sometimes lead to hand or finger stiffness. This condition can be improved with:

• Physical therapy
• Surgical removal of the hardware – pins, screws, or plates – blocking movement
• Medical procedures for reducing scar tissue on associated tendons

Most individuals with boxer’s fracture regain the full use of their hands. Recovery time is often in the span of 12 weeks.