A case of Boxer’s Fracture reported in NEJM

Dr Naoki Yoshida, at Tohoku University Hospital, Sendai, Japan and colleagues have reported a rare case of Boxer’s Fracture. The case has appeared in the New England Journal of Medicine.

A boxer's fracture is a breakthrough the bones of the hand that form the knuckles. Some doctors use the term "brawler's fracture" rather than "boxer's fracture" because a boxer is not likely to get this injury. The less well-trained brawlers have to learn how to punch without hurting themselves. Boxer's fractures occur in the fourth and fifth metacarpal bones.Hand injuries of this sort are most prevalent among fifteen- to thirty-five-year-old males, and the fifth metacarpal is the one most commonly affected.

When a boxer's fracture occurs, it is possible for a portion of the metacarpal bone to move out of normal alignment. This is called angulation. The amount of angulation will determine what type of treatment is required to ensure proper healing. People with boxer's fractures who have acceptable amounts of angulation may be splinted in the emergency department or doctor's office.

A 56-year-old man presented to the emergency department with pain in his right hand after he hit a desk in frustration during an argument at work. On physical examination, there was swelling at the base of the fifth digit, with no open wound. A plain radiograph of the right hand showed a fracture at the neck of the fifth metacarpal (arrow). Sometimes called a boxer’s fracture, this injury typically occurs when a person punches an object with a closed fist.

Despite its name, the fracture is uncommon among professional boxers and typically occurs among untrained persons punching without proper technique. In our patient, because the fracture had created an angulation of greater than 30 degrees and the injury was to his dominant hand, he was treated with percutaneous intramedullary nail fixation and cast immobilization. At follow-up 5 months after surgery, he had regained full use of his right hand.

For more details click on the link: DOI: 10.1056/NEJMicm1813737