Boxer's Fracture
You have a fracture, or break, of one of the bones in your hand. A boxer's fracture usually refers to a break of the hand bone under your pinky finger.
The bones of your hand are called metacarpal bones. They connect the bones of your fingers (phalanges) to the bones of your wrist (carpals). The fifth metacarpal is the metacarpal of the fifth finger (pinky). A metacarpal bone has a long section of the bone (shaft) connected to the end of the bone. The area where the shaft connects to the end of the bone is called the neck. The neck is the weakest point of the bone. This is where a boxer's fracture happens. A boxer's fracture is named so because it is often caused by punching a hard surface with a clenched fist.
A boxer's fracture causes pain, swelling, tenderness, and sometimes bruising near the base of the pinky finger. An uncomplicated—closed, not angulated, and not malrotated—Boxer’s fracture is immobilized with an ulnar gutter splint or a cast. It takes about 4 to 6 weeks to heal.
Surgery may be needed for open fractures, severely comminuted fractures (if the bone is broken in two or more places), fractures associated with neurovascular injury, and malrotation (your pinkie finger crosses over your ring finger when you try to bend it). Surgery may be recommended for people who use their hands for fine motor skills, like pianists, dentists, and watchmakers.
If there are wounds near the fractured joint from hitting someone in the mouth, antibiotics may be needed to prevent an infection. After the bone has healed, a slight cosmetic deformity may remain. It is common for one knuckle to be slightly lower than the others, even if the bone was set. This may be seen only when you make a fist. It usually won’t affect hand function.
Home care
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Elevate. Keep your arm raised to reduce pain and ease swelling. When sitting or lying down, raise your arm above the level of your heart. You can do this by placing your arm on a pillow that rests on your chest or on a pillow at your side. This is most important during the first 48 hours after injury.
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Ice. Apply an ice pack over the injured area for no more than 20 minutes. Do this every 3 to 6 hours, or as directed by your health care provider, for the first 24 to 72 hours. To make an ice pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put ice or an ice pack directly on the skin. You can place the ice pack inside the sling and directly over the splint or cast. As the ice melts, be careful that the cast or splint doesn’t get wet.
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Keep the cast or splint dry. Keep the cast or splint dry at all times. Bathe with your cast or splint out of the water and protected with two large plastic bags. Place one bag around the other. Tape each bag with duct tape at the top end or use rubber bands. Even when the cast or splint is covered, water can leak in. So it's best to keep the cast or splint away from water. If a fiberglass cast or splint gets wet, you can dry it with a hair dryer on a cool setting.
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Medicines. You may use over-the-counter pain medicine to control pain, unless another pain medicine was prescribed. Talk with your provider before using these medicines if you have chronic liver or kidney disease, ever had a stomach ulcer or GI (gastrointestinal) bleeding, or take blood thinners.
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Injury. If you cut, punctured, or scraped your hand during this injury, there is a risk of infection. Watch for signs of infection listed below. Finish any antibiotics you were prescribed.
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Protect your hand while it's healing. Don’t use your injured hand until your provider tells you that it’s safe to do so.
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Quit smoking and avoid secondhand smoke. This will speed up your recovery.
Follow-up care
Follow up with your health care provider within 1 week, or as advised. This is to be sure the bone is healing as it should.
If X-rays were taken, you will be told of any new findings that may affect your care.
If physical therapy is recommended, you'll do passive and active range-of-motion exercises to strengthen the muscles of your hand and prevent stiffness of the joints.
When to get medical advice
Contact your health care provider right away if any of these occur:
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The cast or splint becomes wet or soft.
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The cast becomes loose.
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There is increased tightness or pain under the cast or splint.
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Your fingers become swollen, cold, blue, numb, or tingly.
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The splint or cast has a bad smell, or wound drainage stains the cast.
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You have signs of infection. These include fever, redness, warmth, swelling, or drainage from the wound.
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You have chills.
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You have a fever of 100.4°F (38°C), or as directed by your provider.