What is a boxer’s fracture?

A boxer’s fracture is a break in the neck of the 5th metacarpal bone in the hand. It gets its name because the injury is common in inexperienced boxers.

The metacarpal bones are the intermediate bones of the hand found inside the flat part of the hand. They connect the bones of the fingers (the phalanges) to the bones of the wrist (the carpals). The 5th metacarpal is the metacarpal of the 5th (pinky) finger. The neck of the metacarpal bone is where the main shaft of the bone starts to widen outwards towards the knuckle.

Boxers are not the only people who can get a boxer’s fracture, but usually the injury results from direct injury to a clenched fist. The force fractures the neck of the metacarpal bone below the pinky.

Your healthcare provider will need to make sure you have a boxer’s fracture and not another type of metacarpal fracture, like a break at the shaft of the metacarpal or a fracture at the base of the small finger. These injuries may need different treatments.

Metacarpal bones are some of the most commonly broken bones in the hands. A large number of these are boxer’s fractures.

What causes a boxer’s fracture?

Usually, a boxer’s fracture happens when you punch a wall or another solid object at a high speed. You also might get a boxer’s fracture if you fall hard on your closed fist. The neck of the metacarpal bone is its weakest point, so it tends to fracture here.

What are the symptoms of a boxer’s fracture?

Symptoms of a boxer’s fracture can include:

• Painful bruising and swelling of the back and front of the hand

• Pain of the back of the hand in the area of the fractured 5th metacarpal

• Bent, claw-like pinky finger that looks out of alignment

• Limited range of motion of the hand and of the 4th and 5th fingers

Your knuckle may also not have its normal bumpy shape. Your symptoms may vary in severity depending on the complexity of your fracture. You might have only mild pain, or the pain might be more severe.

How is a boxer’s fracture diagnosed?

Your healthcare provider will ask you about your symptoms, how you injured the hand, and your past medical problems. Your provider will also examine your hand carefully, checking for pain, strength, misalignment, range of motion, breaks in the skin, and other problems.

An X-ray of the hand can clearly confirm a boxer’s fracture.

How is a boxer’s fracture treated?

Your treatment depends on how severe the fracture is. Initial treatment might include:

• Resting your hand for a few days

• Keeping your hand above the level of your heart for a few days

• Icing your injury several times a day

• Taking pain medicine (prescription or over-the-counter)

• Wearing a splint or cast for several weeks

Before your healthcare provider puts your hand into a splint, they may need to put your bones back into alignment. You’ll usually receive a local anesthetic to keep you from feeling any pain, and your provider will move the bones back into place. A splint is often used for the first few days, until swelling decreases. The provider will then put a cast on you. It will stay in place for rest of the healing period. In some cases, you may need surgery to get the bones back into alignment.

You also may need to work with a physical therapist for a while as your fracture heals. You’ll learn exercises to strengthen the muscles of your hand and keep them from getting stiff.

If you have an unusually severe boxer’s fracture, you may need immediate and more complicated surgery. For example, if your bone has broken through the skin, or if it has broken in several places, you will probably need surgery. You might also need surgery if you have a job or hobby that needs a lot of fine-motor movement of the hand, like playing the piano.

Even if you don’t need surgery right away, you might need it at some point. If your hand doesn’t heal as well as expected, surgery might be a choice.

What are possible complications of a boxer’s fracture?

An untreated boxer’s fracture can lead to a decrease in your ability to grip, limited range of motion of the finger, and an abnormal looking finger. With treatment, these problems are usually minor, if they happen at all.

What can I do to prevent a boxer’s fracture?

Avoid fistfights and punching solid objects to prevent many cases of boxer’s fracture. If you box, make sure you use the correct method and equipment.

How to manage a boxer’s fracture

Your healthcare provider may give you some instructions about how to manage your boxer’s fracture, such as:

• Keep your bones strong by eating a healthy diet with enough vitamin D, calcium, and protein

• Stop smoking to help your fracture heal more quickly

• Keep your splint or cast from getting wet

Your hand will be very easy to injure again for 4 to 6 weeks after your splint is gone. You may need to use a hand brace if you return to contact sports during this time. Talk with your healthcare provider about what makes sense for you.

When should I call my healthcare provider?

Call your healthcare provider if:

• You have numbness or tingling in your fingers

• Your fingers look blue

• You have severe pain or swelling that gets worse

• Your splint or cast gets damaged or wet and you need a new one

Key points about a boxer's fracture

A boxer’s fracture is a break in the neck of the 5th metacarpal bone in the hand. It usually happens when you punch an object at a high speed.

• Symptoms of a boxer’s fracture include pain and swelling of the hand, limited range of motion of the pinky finger, and misalignment of the finger.

• Your healthcare provider can diagnose your boxer’s fracture with a health history, physical exam, and X-ray.

• You might need treatment that includes simple rest, ice, pain medicine, and splinting.

• You might need surgery for your injury if it is severe.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends and holidays.