5th Metacarpal Fracture (Boxer’s Fracture)
What is a Displaced 5th Metacarpal Fracture?
The 5th Metacarpal is the bone under your little finger and a break in the neck or shaft of this bone is known as a 5th metacarpal fracture, where bone fragments are displaced.
Boxer’s Fracture
A Boxer’s fracture specifically refers to a fracture of the neck of the 5th metacarpal bone, which is the narrow area just below the knuckle of your little finger. It commonly occurs when someone punches a hard object.
Causes
5th metacarpal fractures are typically caused from punching a hard object, like a wall or punching bag, or a direct blow to a closed fist. It can also happen from falls or crushing trauma from sports injuries, like boxing,
5th Metacarpal Fracture Symptoms
During a 5th Metacarpal fracture, you may experience the following signs and symptoms
- sudden acute pain
- swelling or bruising,
- tenderness around the injured area
- difficulty in moving your fingers and hand
- Deformed knuckles shape and visible displaced bone
5th Metacarpal Fracture First Aid
Typically, in fracture treatment R.I.C.E therapy is your first line of aid, which has further been developed using the P.O.L.I.C.E and NO HARM principles.
1. If you are sure that your 5th metacarpal bone is displaced, you need to immobilise it immediately using a wrist brace or splint.
2. Apply icing (use ice pack if available) for 15 to 20 mins (or longer if required) every hour or two for the next 24 to 48 hours
3. Keep your hand elevated above heart level, as this promotes excess fluid drainage and reduces blood flow towards the injured area thereby minimizing inflammation.
4. You may take pain relief medication, like paracetamol, with advice from your doctor.
Treatment Options
Non-surgical (most common):
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Reduction: Once diagnosed, manual realignment of the bone is required to ensure bone fragments are back in-place. Your doctor may apply local/regional anaesthetic if necessary
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Immobilisation: a wrist brace or splint may be used to immobilise the injury. In some cases, buddy-taping the little finger with the ring fingers also works. A forearm sling may also be used to ensure consistent elevation of the injured area.
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Movement: Your doctor may advise you to start gentle movements within a few days to prevent finger, hand, wrist and forearm stiffness. Early movement can help improve the healing process and recover your mobility.
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Physiotherapy: Physiotherapy or hand therapy is helpful once your bone has healed. This is complemented with gradual weight-bearing also known as optimal loading.
Surgical (for complex cases):
Surgical treatment of your 5th Metacarpal or Boxer’s fracture usually involves fixation using K-wires, screws, and or plates. This type of treatment is required if your X-ray indicates any of these symptoms
- severe angulation,
- rotational deformity,
- intra-articular involvement,
- open fractures,
- neurovascular effect
How is it diagnosed?
How long does a 5th metacarpal fracture take to heal?
Most 5th metacarpal fractures respond well to conservative treatment and heal in 6 to 8 weeks. You may recover full function in 3 to 4 months. Post-fracture management may be required to ensure full and timely recovery.
Do I need to go to the hospital for a 5th metacarpal fracture?
It’s important to know when there is no need to visit a hospital for a fracture. In most cases, visiting a GP is appropriate for initial assessment and treatment of your 5th metacarpal fracture. Your GP may refer you to an Orthopaedic specialist if required. Most cases are non-emergency injuries, and can be handled without rushing to hospital ER or ED. You may need to access a clinic that offers X-rays and CT scans for correct diagnosis. Rushing to ED is only advised if there is acute deformity, open wound, or signs of crushing trauma causing unbearable pain.
When is the 5th metacarpal fracture a serious injury?
If there’s rotational deformity, open wound, numbness, severe misalignment, or impaired blood flow—these situations often require urgent care.
What are the complications of a 5th metacarpal fracture?
5th metacarpal fracture complications may include malunion or nonunion (if not treated correctly), rotational deformity, stiffness and grip weakness, or knuckle flattening. In some surgical cases there may be infection.
Does Medicare cover this treatment?
Medicare mostly covers bulk-billed GP and public hospital ED admissions. X-ray, scans, and specialists may require gap payment of 15%. If you have private insurance, it can reduce hospital and therapy costs.
