Young Athlete Center: July 2016

by Charles Goldfarb, MD

One of the most common hand injuries in the athlete is a broken hand bone or metacarpal fracture. These injuries happen for a number of reasons- direct force such as in football, a slash across the hand in in hockey, or a punching force in any sport (or non- sport). The most common metacarpal fracture is often called a 'boxer's fracture'. It is actually not a good name because boxers don't get this fracture because they understand how to safely punch. This fracture happens to the pinky finger metacarpal when the force of a punch (or something similar) is absorbed by the metacarpal. We most commonly see this fracture when an adolescent or young adult male punch someone or something.

Thankfully, most of these 'boxer's fractures' heal uneventfully in a cast or in a brace. Typical healing time is 6-8 weeks. Once healed, people get back to activities but sometimes notice that their knuckle is not quite as visible. But function is usually normal.

Rarely, this fracture may not do well in a cast or splint due to more angulation or deformity. Doctors do not agree on what degree of angulation is safe but when the angle is too severe, a reduction to put the bones back in better alignment or a surgery are often recommended.

The following patients injured himself in basketball and had a notable deformity measuring almost 90 degrees. Most doctors would agree that this is too much deformity and something should be done. I believe the fracture is clear on the little finger metacarpal.

Severe boxers fracture, 5th metacarpal neck fracture

Severe boxers fracture, 5th metacarpal neck fracture
The angulation is about 90 degrees.

In this image, I have added an arrow to point out the angulation of the metacarpal bone in case it is not clear.

Boxers fracture with arrow demonstrating the angulation which measures about 90 degrees.

The patient was taken to the operating room and the fracture was able to be reduced (ie, pushed back into place) without an incision. However, as expected, it was unstable- it kept falling back out of position. Therefore, we placed two k- wires to hold the bones in position. These pins or wires will stay in place for about 6 weeks and then we can take them out in clinic (almost painless process). Depending on the healing, the patients may have to stay out of physical sports for 8-10 weeks.