UMEM Educational Pearls

Category: Visual Diagnosis

Title: What's wrong with this picture? (Don't scroll too far down)

Keywords: boxer's, fracture, orthopedics, hand, brawler's, radiology, xray (PubMed Search)

Posted: 1/17/2011 by Haney Mallemat, MD
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Boxer's (or Brawler's) Fracture

  • Fifth metacarpal neck fracture, usually secondary to a direct blow or closed-fist impact.
  • Potentially an unstable fracture and difficult to maintain reduction due to tension from tendons and muscles in the hand.
  • Up to forty degrees of angulation can be tolerated without repair, although there is potential for reduced hand function without repair. Any rotational deformity, however, must be corrected.
  • Non-displaced fractures: RICE therapy, gutter splint, and Ortho follow-up.
  • Displaced, rotated, or angulated fractures (>40 degrees): closed reduction may be attempted but surgical fixation usually required.


Many thanks to Dr. George Kochman for submitting this case!