Emergent care / stabilization: Immobilization and pain control.

Causes / typical injury mechanism: A boxer's fracture is defined specifically as a fracture to the subcapital or neck of the fifth metacarpal in the setting of direct trauma to a clenched fist. Trauma is typically distributed axially through the fifth metacarpal. Most commonly, there is apex-dorsal angulation secondary to the tension of the hand's interossei muscles. Additionally, a boxer's fracture can occur from direct trauma to the dorsum of the hand.

Classic history and presentation: History typically includes a report of punching with a clenched fist with force applied axially. This injury is commonly sustained while punching solid objects and/or at athletic events. This is not commonly associated with falling onto an outstretched hand (FOOSH), as is typical of most other hand fractures. Patients often report pain to the dorsum of the hand with associated swelling and/or deformity.

Prevalence: About 30%-40% of fractures of the hand involve the metacarpals. About 10% of all hand fractures are boxer's fractures. Boxer's fractures are observed 5 times more frequently in males between the ages of 10 and 29 years than in females.