Overview
what it is and why it matters
Metacarpal fractures are among the most common hand fractures seen in the emergency department. The "boxer's fracture" specifically refers to a neck fracture of the ring or small finger metacarpal from a direct axial load — punching a wall or another person. The head angulates volarly, producing a depressed knuckle.
Other metacarpal fractures (shaft, base, index/middle neck) require more scrutiny for rotation, shortening, and intra-articular extension.
Diagnosis
exam first, imaging secondPA, lateral, and oblique hand X-rays define fracture pattern, apex angulation, shortening, and rotation. Rotational malignment is best assessed clinically: flexing all fingers toward the scaphoid — any finger that crosses or gaps is rotated. Up to 40° of apex-dorsal angulation is acceptable at the ring/small metacarpal neck; less angulation is acceptable at the index and middle metacarpals.
Treatment Path
how care progresses at OSI1
Buddy taping and functional splint
For minimally displaced, non-rotated small/ring finger neck fractures.
2
Ulnar gutter splint
Immobilizes ring and small finger neck fractures in the position of intrinsic-plus (70–90° MCP flexion) for 3–4 weeks.
3
Closed reduction
When angulation exceeds acceptable limits, the fracture is reduced under a digital block using the Jahss maneuver.
Surgical Options at OSI
if non-operative care isn't enoughSurgery is indicated for rotation, shortening >4–5 mm, intra-articular CMC fracture-dislocations, and fractures that cannot be held in reduction.
Providers Who Treat Metacarpal (boxer's) Fracture
sports-medicine team
David B. Templin, M.D.
Trent Twitero, M.D.
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: