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Boxer's FractureAka: Fifth Metacarpal Neck Fracture

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  1. Definition
    1. Fracture of neck of fifth metacarpal (pinky finger)
  2. Mechanism
    1. Often injured in fist fights
  3. Signs
    1. Swelling over Fracture
    2. Depression of involved knuckle
  4. Imaging: Hand XRay
    1. Distal Fracture fragment with volar angulation
      1. Maximum acceptable angulation: 40 degrees
      2. Reduction should aim to minimize angulation
  5. Management
    1. Impacted Fracture with minimal angulation
      1. May be effective even for angulation up to 70 degrees
      2. Compression dressing for 1 week
      3. Then gradually increase Exercises
      4. Statius (2003) Arch Orthop Trauma Surg 123:534
    2. Fracture angulated greater than 40 degrees
      1. Consider reduction even for <40 degree angulation
      2. Closed Reduction (see below)
      3. Immobilization as described below
      4. Open Reduction and Internal Fixation (ORIF)
        1. Indicated for persistent angulation >40 degrees
  6. Management: Closed Reduction
    1. Anesthesia: Hematoma Block or Ulnar Block
    2. Procedure
      1. Flex at affected MCP joint to 90 degrees
      2. Stabilize proximal metacarpal
      3. Direct pressure dorsally at distal angulated fragment
    3. Immobilization
      1. Splint MCP in 70-90 degrees flexion for 6 weeks
      2. Ulnar gutter splint or glove cast
    4. Follow-up
      1. Repeat XRay every 2 weeks to evaluate healing
      2. Exercises start after immobilization
    5. Return to play recommendations (variable guidelines)
      1. Consider waiting until symmetric strength and ROM
  7. Orthopedic referral indications
    1. Angulation >40 degrees
    2. Rotation (evaluated with XRay or Hand Exam)
      1. OrthoHandPositionFistToScaphoid.jpg
  8. Complications: Excessive volar angulation
    1. MCP stiffness or pain
    2. Persistent protruding bump at MCP
      1. May occur even without significant angulation
  9. Prognosis
    1. Good functional result even with some angulation
    2. Knuckle will never appear as prominent

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