Boxer's fracture

A "Boxer's fracture" occurs as a result of axial loading of the 4th and/or 5th transverse neck of the metacarpal bone secondary to an indirect force such as striking an object with a closed fist. Anatomy There are approximately 29 bones in the hand and wrist together, 5 of which are called the metacarpals. The metacarpals lie in the region between the proximal phalange bones and the carpal bones. Boxers fracture generally occurs in the 4th and/or 5th metacarpal of the hand.[2] More specifically, the fracture happens in the neck region in the distal end of the metacarpal. The bone itself is located between the joints called the metacarpophalangeal joint and the carpometacarpal joint. The fracture occurs just below the head of the metacarpal which is the neck region of the metacarpal.[3] The neck is the most susceptible and prone to breaks because it is the most fragile part of the metacarpal.[4] [edit]Causes BoxerТs fractures are usually caused by the impact of a clenched fist with a skull or a hard, immovable object, such as a wall.[5] The knuckle of the index finger tends to lead the rest of the knuckles in a hard punch, and the knuckle compresses and snaps the neck of the metacarpal bone. When a boxer punches with proper form, the knuckles of the second and third metacarpal align linearly with the articulating radius, followed linearly by the humerus. As a proper punch makes contact, the force should tra

el from the rotating body across the humerus, straight across the radius, straight across the second and third metacarpals, finally transferring all the momentum and force from the respective knuckles to the point of contact. Due to the linear articulation of bones, the force is able to travel freely across these joints and bones. However, improper form causes the break to occur at an angle towards the palm, creating a dorsal bump, which ultimately causes the fracture, as the knuckle of the index finger tends to lead the rest of the knuckles in a hard punch, and the knuckle compresses and snaps the neck of the metacarpal bone.[6] [edit]Symptoms The symptoms are pain and tenderness in the specific location of the hand, which corresponds to the metacarpal bone around the knuckle. When a fracture occurs, there may be a snapping or popping sensation. There will be swelling of the hand along with discoloration or bruising in the affected area. Cuts on the hand are also likely to occur. Movement of the bone may be limited due to the fracture and pain may be inflicted if movement occurs in the specified area. Lastly there could be a misalignment of the finger. [edit]Diagnosis Diagnosis by a doctorТs examination is the most common, accompanied most often by x-rays. X-ray is used to display the fracture and the angulations of the fracture. A CT scan may be done in very rare cases to provide a more detailed picture.