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Do I have a boxer's fracture?

Q: I am a 19 years old girl who got hit on the knuckle with a toy car 2 days back. At first, it hurt a little but now it seems to be paining all the time. I tried putting ice on it and wrapping it in cloth but it hurt even more. My hand is bruised and swollen around the knuckle and seems to be a little discoloured too. I can bend my fingers but it hurts whenever I do it. Do I have a boxer's fracture?

A:Metacarpal neck fractures (Boxers fracture) are common and usually involve the ring and small fingers. Boxer’s fracture is really a misnomer. Fractures of the fifth metacarpal neck are rarely seen in professional boxers; they are far more common in brawlers and in people who hit solid objects (in your case). The involvement of the finger depends upon the area of contact. It is index (second metacarpal neck) finger in your case. I would like you to check yourself the following simple tests to detect the fracture pattern:

  1. Place the palm on the table looking your face; then try bending all your fingers. Look for any scissoring or overlapping of your fingers (especially index and middle fingers). If you don't have then, it means there is no rotation of the fracture of 2nd metacarpal.
  2. If the knuckle is depressed compared to the other fingers, it means there is angulation. It is expected in this fracture.
I would advise you not to panic about the swelling, bruises in the hand because it will be there in these fractures. The best way to reduce swelling is to keep the hand elevated above the heart level even during sleep. Take painkillers (Tab. Voveran 100 mg thrice daily with Tab. Ocid 20 mg once a day) and Wrist splint (functional brace) or Buddy tapping (keep your index and middle finger together strapped with a bandage or a sticky plaster) if you can get it over the counter. The swelling and bruises will get reduced gradually over a period of time (5-7 days). The fracture will become sticky at the end of 3 weeks and union at the end of 3 months. Nonunion virtually never occurs; however, malunion may be the problem. Controversy exists regarding the optimum treatment of this fracture, which varies from NO surgery to variety of surgery techniques. But, the overall consensus is:
  • Those with functional brace have faster return to work.
  • No significant disability with up to 70 degree of angulation.
  • No relationship between the presence of symptoms and angulation.
  • There will be a detectable loss of knuckle prominence which wont affect the normal daily activities.

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