3Ĭlosed reduction is indicated if there is unacceptable angulation or rotational malalignment. Open fractures, involvement of multiple metacarpals, and fractures with neurovascular compromise require surgical consultation. In addition, patients should be treated with analgesia, ice, and elevation in the first 72 hours. It is important to thoroughly examine for any abrasions or lacerations before attempting reduction and immobilization. 2Įmergency department management of an uncomplicated boxer's fractures (nondisplaced or minimally displaced, no rotational deformity, acceptable angulation) entails conservative care with immobilization. This is because a fight bite injury significantly alters the management course, carrying the implication of surgical management and antibiotic coverage to avoid significant morbidity.ĪP and oblique radiographic views of the hand should be obtained, and lateral views may help in assessing the degree of bony displacement and angulation along with any other potential injuries at the carpometacarpal joint.
Particularly if there is a dorsal laceration over the MCP joint, it is important to press the patient for a true mechanism of injury.
The patient may be hesitant to disclose the mechanism of injury if it occurred during a fight for fear of repercussion or embarrassment. Making the diagnosis entails a thorough history, detailed examination, and proper imaging. There is also usually volar displacement of the metacarpal head due to the force vector across the metacarpophalangeal (MCP) joint during a closed-fist strike. The colloquial term “boxer's fracture” is generally used to describe a metacarpal neck fracture of the small finger. 1 Metacarpal fractures commonly occur around the metacarpal neck as a result of direct contact of an object (or person) with a closed fist. Hand and wrist injuries account for 15-25% of ED-related musculoskeletal injuries. His X-ray reveals an angulated metacarpal neck fracture. There is weakness with finger flexion, but he is otherwise neurovascularly intact. On presentation, his exam is remarkable for swelling of the entire left hand with tenderness noted along the dorsal aspect of the left 4 th metacarpal. He pulled on his finger to alleviate the pain and continued playing.
He heard a “crunching” sound and assumed he jammed his ring finger. The patient reports that his hand was forced into the ground during a tackle. A 21-year-old male presents to the emergency department (ED) with pain and swelling in his left hand several hours after an injury that occurred while playing football with his friends.
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