Boxer's Fracture

Case 1

This one is fairly straightforward:

A 17 year-old male comes into the clinic on Friday afternoon, complaining of pain and swelling along the outer aspect of his right hand.

It seems that earlier that week, he had gotten into an argument with his girlfriend and, out of frustration, punched the wall.

X-rays were obtained.


Boxer's fracture; the annotated x-ray

What is the diagnosis?
Boxer's fracture

Boxer’s fracture is a break in the neck of the fifth metacarpal. I see 2-3 boxer’s fractures a year, almost always from guys punching a wall or a home appliance (and losing).

Text and images are courtesy of Scott from Politedissent.com and are used with permission.


Case 2

28 yo AAM came to ER after punching a wall because he felt anxious. He c/o swollen right hand. No hallucinations, delusions or suicidal ideas.

PMH:
paranoid schizophrenia

Physical examination:
Ext: edema over the dorsum of the right hand with tenderness over the 5th metacarpal, extremity pulses equal and symmetric.

X-ray of right hand: 5th metacarpal fracture with angulation


Boxer's fracture

X-ray report:
There is a fracture of the neck of the fifth metacarpal with adjacent soft tissue swelling. There is radial and palmar angulation of the distal fracture fragment. Additional fractures are not seen. Joint spaces are maintained.

What happened?
Plastic Surgery (hand) was consulted and a reduction with splint was applied. The patient's hand neurovascular status was intact pre and post reduction.

Repeat films will be obtained in the AM.

Final diagnosis:
Right 5th metacarpal fracture


References:
Boxer's fracture - E-hand.com
Name that diagnosis - Politedissent.com