Boxer's fracture
Encyclopedia
A "Boxer's fracture" is the second and/or third metacarpal transverse neck fracture that is more likely to occur from a straight punch. The "Boxer's" designation is suggestive of the generally well tolerated way of striking a hard object with the closed fist, with the second and third metacarpal bones absorbing most of the force.
A "Bar Room fracture" is a transverse fracture of the fourth and/or fifth metacarpal neck. The "Bar Room" designation is suggestive of an inexperienced and/or intoxicated fighter that throws a "round house" type punch, with the fourth and fifth metacarpal bones absorbing most of the force. This is generally accepted to be an unfavorable way of landing a punch.
Most recently the terms "Boxer's" and "Bar Room" are used interchangeably to refer the second and third, and the fourth and fifth metacarpal fractures.
It is usually caused by the impact of a clenched fist with a skull or a hard, immovable object, such as a wall. 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.
is optimally performed by the Jahss maneuver, in which the metacarpophalangeal joint
(MCP) and proximal interphalangeal joint (PIP) are flexed to 90 degrees, causing reduction by tightening of the collateral ligament
s of the MCP. Subsequent splinting is performed with the MCP joint remaining flexed to avoid tendon contracture
.
Severe angulation requires pins to be put in place and realignment as well as the usual splinting. However, the prognosis on these fractures is generally good, with total healing time not exceeding 12 weeks. The first two weeks will show significantly reduced overall swelling with improvement in clenching ability showing up first. Ability to extend the fingers in all directions appears to improve more slowly. Hard casts are rarely required and soft casts or splints can be removed for brief periods of time to allow for activities such as showers and "airing out" the cast or splinted area so as to avoid skin rotting and permit cleansing of the cast or splinted area. Pain from this injury is generally very mild and rarely requires medications beyond over the counter drugs such as ibuprofen or acetaminophen. Muscle atrophy in isolated areas of 5 to 15 percent should be expected with a rehabilitation period of approximately 4 months given adequate therapy. In the mildest of cases, full rehabilitation status can be achieved within 3 to 4 months.
For smaller angled fractures most discomfort is alleviated by raising the fracture above the heart
; after swelling has subsided, if there is no cast, warm water can be used to relieve some of the pain. It is important that when the cast is removed that the hand is gently exercised by attempting the common functions in the hand.
and other combat athletes
routinely use hand wraps and boxing gloves
to help stabilize the hand, greatly reducing pain and risk of injury during impact training such as working the heavy bag
. Hand wraps are made with typical athletic tape.
A "Bar Room fracture" is a transverse fracture of the fourth and/or fifth metacarpal neck. The "Bar Room" designation is suggestive of an inexperienced and/or intoxicated fighter that throws a "round house" type punch, with the fourth and fifth metacarpal bones absorbing most of the force. This is generally accepted to be an unfavorable way of landing a punch.
Most recently the terms "Boxer's" and "Bar Room" are used interchangeably to refer the second and third, and the fourth and fifth metacarpal fractures.
Causes
Treatment
A conservative approach to healing can be attempted for cases with only minor angulation. Initial reductionReduction (orthopedic surgery)
Reduction is a medical procedure to restore a fracture or dislocation to the correct alignment. When a bone fractures, the fragments lose their alignment in the form of displacement or angulation. For the fractured bone to heal without any deformity the bony fragments must be re-aligned to their...
is optimally performed by the Jahss maneuver, in which the metacarpophalangeal joint
Metacarpophalangeal joint
The metacarpophalangeal joints are of the condyloid kind, formed by the reception of the rounded heads of the metacarpal bones into shallow cavities on the proximal ends of the first phalanges, with the exception of that of the thumb, which presents more of the characters of a ginglymoid joint...
(MCP) and proximal interphalangeal joint (PIP) are flexed to 90 degrees, causing reduction by tightening of the collateral ligament
Collateral ligament
Collateral ligament can refer to:* Fibular collateral ligament* Lateral collateral ligament* Medial collateral ligament* Collateral ligaments of interphalangeal articulations of foot* Collateral ligaments of metatarsophalangeal articulations...
s of the MCP. Subsequent splinting is performed with the MCP joint remaining flexed to avoid tendon contracture
Contracture
A muscle contracture is a permanent shortening of a muscle or joint.. It is usually in response to prolonged hypertonic spasticity in a concentrated muscle area, such as is seen in the tightest muscles of people with conditions like spastic cerebral palsy....
.
Severe angulation requires pins to be put in place and realignment as well as the usual splinting. However, the prognosis on these fractures is generally good, with total healing time not exceeding 12 weeks. The first two weeks will show significantly reduced overall swelling with improvement in clenching ability showing up first. Ability to extend the fingers in all directions appears to improve more slowly. Hard casts are rarely required and soft casts or splints can be removed for brief periods of time to allow for activities such as showers and "airing out" the cast or splinted area so as to avoid skin rotting and permit cleansing of the cast or splinted area. Pain from this injury is generally very mild and rarely requires medications beyond over the counter drugs such as ibuprofen or acetaminophen. Muscle atrophy in isolated areas of 5 to 15 percent should be expected with a rehabilitation period of approximately 4 months given adequate therapy. In the mildest of cases, full rehabilitation status can be achieved within 3 to 4 months.
For smaller angled fractures most discomfort is alleviated by raising the fracture above the heart
Heart
The heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
; after swelling has subsided, if there is no cast, warm water can be used to relieve some of the pain. It is important that when the cast is removed that the hand is gently exercised by attempting the common functions in the hand.
Prevention
BoxersBoxing
Boxing, also called pugilism, is a combat sport in which two people fight each other using their fists. Boxing is supervised by a referee over a series of between one to three minute intervals called rounds...
and other combat athletes
Mixed martial arts
Mixed Martial Arts is a full contact combat sport that allows the use of both striking and grappling techniques, both standing and on the ground, including boxing, wrestling, Brazilian jiu-jitsu, muay Thai, kickboxing, karate, judo and other styles. The roots of modern mixed martial arts can be...
routinely use hand wraps and boxing gloves
Boxing gloves
Boxing gloves are cushioned gloves that fighters wear on their hands during boxing matches. The term also refers to gloves used in training, though these often differ from competition gloves...
to help stabilize the hand, greatly reducing pain and risk of injury during impact training such as working the heavy bag
Punching bag
A punching bag or punch-bag is a sturdy bag designed to be repeatedly punched. It's used for conditioning, physical exercise, and stress relief...
. Hand wraps are made with typical athletic tape.
External links
- http://www.med.umich.edu/1libr/sma/sma_meta5car_art.htm
- http://www.wheelessonline.com/ortho/boxers_fracture_metacarpal_neck_1