Boxer's Fracture

Boxers Fracture

A Boxer's fracture is a break to either the 4th or the 5th Metacarpals which are the long bones on the outside of the hand. As the name indicates, this injury is usually caused by a hard impact against the hand, like a punch. Read more about how this hand injury can be treated.

Symptoms of a boxer's fracture

Boxer's fractures are usually caused by punching something hard such as a wall or falling onto a fist. The patient will experience instant severe pain in the hand at the time of injury with swelling developing quickly possibly followed by bruising.

The outside edge of the hand where the fracture is will be particularly tender to touch and moving the hand will be painful. The knuckle on the outside may appear dropped.


Fractures to these two bones are known as boxer's fractures due to the most common cause of injury being a punch. This can be to a wall or other hard surface such as someone's head. The stress through the bone causes a break in the weakest area which is the neck of the bone, just below the knuckle.

Boxer's fracture treatment

Medical attention should be sought immediately if a fracture of the hand is suspected. An X-ray can confirm the diagnosis. If the bone is aligned still then it may just be immobilized in a cast or splint to allow the bone to heal and most will heal without further problems. If however the bone is displaced or out of alignment then it may need to be set and held in place with pins, which requires surgery.

Boxer's fracture surgery

Mr. Elliot Sorene MBBS FRCS (Tr & Orth) EDHS Consultant Orthopaedic, Hand & Upper Limb Surgeon explains surgery for Boxer's fracture of the hand.

A boxer's fracture is more commonly associated with a fall onto a fist or a patient punching something hard like a wall.

This causes the neck of the 5th metacarpal in the hand to break causing the knuckle to descend and look deformed.

If this injury is just left then it can cause a future problem of the patient not being able to extend their little or pinky finger. Some Boxers fractures can be manipulated back into place (reduced) without surgery and put in plaster.

Those that are significantly angulated or bent will need to be operated on and there are a variety of techniques and the surgeon's disposal. One elegant technique is to run a wire up the bone to fix the knuckle back on and hold it in place. This allows the patient to move their hand immediately after surgery. They will then wear a removable splint and with hand therapy and exercises they can certainly get a good result.

There are certain fractures of a more complicated nature which will require putting a little plate and screw in to hold the bones in place while they heal.

It is extremely important to restore normal function back to this part of the hand so the little finger can bend properly, not just for boxers but because it is used in gripping and so many other activities we require the hands for.