A boxer's fracture is a fracture at the end of one or more of the metacarpals, the bones in the hand that span from the wrist to the fingers, near the knuckles. This type of fracture most typically results from hitting a hard object with a closed fist, hence the name, which references a sport where such impact injuries are common. It may also be known as a bar room or brawler's fracture, depending on regional slang, and the formal medical term for this injury is a fracture of the neck of the metacarpal.
In this type of injury, patients may notice pain and swelling around the knuckles. Sometimes the break is severe enough to push the bone out of position, in which case it may form an unsightly lump under the skin. Injuries to the knuckles can also include cuts that may expose the bone, and there is a potential for an open boxer's fracture, where bones break through the skin.
The best treatment for a boxer's fracture depends on the nature of the injury. If the fracture is closed, it may be possible to flex the hand to move the bones into position, and then splint them to hold them in place during healing. For open fractures, irrigation of the wound is necessary to clean it, and the patient may require surgery. In surgery, the surgeon can determine if fixators will be necessary to hold the bone in place as it heals.
Athletes like boxers use a number of measures to prevent this kind of fracture. They may pad their hands to distribute impacts, and they also learn how to throw punches to reduce the risk of injury while still dealing a harsh blow to an opponent. The boxer's fracture is more common in new fighters who are not yet fully trained, or people who are not athletes who throw punches in a dispute or who punch walls and other solid objects out of frustration or bad temper.
Failure to treat a boxer's fracture can result in the risk of infection, and could potentially lead to necrosis, where parts of the bone and tissue die because they do not get enough blood. The patient may also have limited mobility in the affected hand because of the poorly healed break, and could develop severe arthritis with age. Since the hands are needed for numerous fine motor tasks, it is critical to provide appropriate treatment for hand injuries to limit the risk of impairments later in life.
