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Specific Discussion On Wrist Boxer's Fracture for Cary, Garner, Raleigh, Chapel Hill and Triangle Patients

A Wrist Boxer's Fracture is a fractured hand—a fracture of the Neck of the 5th long bone of the hand called a metacarpal. This particular broken hand fracture derives its name as it usually occurs as a result of a punching injury. With excessive force the bone may be disrupted into multiple fragments or become significantly displaced resulting in a deformity.
A compound or open fracture results when the bone becomes exposed through the skin increasing risk of infection. This is seen with a punching injury to a tooth creating an opening in the skin.

This specific broken hand fracture results in decreased prominence of the 5th knuckle and can also result in improper rotation of the little finger creating an overlap of the fifth finger over the ring finger. In this event, one will notice loss of grip strength due to this improper alignment. For the most part the 4th and 5th fingers function to provide good grip strength where as the index and mid finger are more utilized for fine motor control activities.

Wrist Boxers Fracture Treatment Goals and Approach

The ultimate goal of treating the wrist boxers fracture or broken hand fracture is to stabilize the fracture site in a good position so that appropriate healing may take place. Casting is normally the treatment of choice and may take 6 weeks to be fully healed. In the event that the wrist boxers fracture is displaced then the physician will most likely perform a "Closed Reduction" which means "resetting" the bones and is usually done under local anesthesia. At times, the fractured hand is unstable, meaning that, most likely, it will not  maintain good position with just reduction and casting. In this event an "Open Reduction" surgical procedure will be required. Typical methods of surgical open reduction involve the use of screws and plates, wires or external fixation devices that hold the wrist boxers fracture in place outside of the actual wrist.

Conservative Wrist Boxers Fracture Treatment Considerations

Initial conservative approach would include Ice, light compression, elevation and physician visit to determine the nature of the injury. In the event a fracture diagnosis is made and is of such a nature that conservative care is the treatment of choice, then casting after closed reduction would occur.

Casting Expectations

In the event that the conservative approach is taken, your fractured hand will be placed in a short arm cast. Overall the arm, wrist and hand should feel comfortable in the cast but you may experience some short term pain and light pressure in the early stages of immobilization. It is important to inform your physician should you feel undue discomfort or recognize significant swelling in the fingers despite pain medicine and elevation of the arm. It is also important to move all joint of the upper extremity that can move while in the cast to prevent stiffness and encourage circulation.

Your treating physician will most likely re-x ray the fractured hand with each office visit, especially in the early stages and particularly if there is any concern about the stability of the fracture site. You may have 1-2 additional cast changes to ensure proper fit and comfort.

Expected Conservative Care Results

Excellent results may be obtained even if normal alignment is not obvious on X-Ray. When a fracture occurs, the healing process will result in a "callus" at the sight in the form of what may be noticed as a bony bump. This "bump" will get smaller with time and is part of the normal healing process.

It takes approximately 6 weeks to completely heal a fracture and often times up to 5 months for full bone strength to be achieved. X-rays may not show evidence of full bony healing until this prolonged time frame has been achieved.

Fractures result in pain and swelling, require splinting or casting to protect the healing fracture site and will normally result in stiffness of the hand and fingers. You will be instructed by your physician and therapist when to resume an outlined exercise program to regain normal use of the hand. It will be important to follow those instructions to achieve the desired results

Specific to Boxer's Fracture it is important to prevent stiffness of the knuckle with early movement before full healing has taken place, assuming the fracture site is stable. Avoid gripping or hand shaking, protect the fingers with "Buddy Taping" of the 5th to the 4th finger to prevent catching the finger on something.

An isolated closed reduction alone is rarely successful due to the instability that occurs once the bone has been put back in normal alignment. Wire insertion through the skin may be used in combination with the closed reduction to insure proper alignment is held. In the event an open reduction is necessary, utilizing an incision and insertion of a plate is required, early movement of the fingers is recommended to prevent additional post operative stiffness.

Surgical indications are directly related to the degree of malrotation of the metacarpal bone and resultant loss of function as it relates to position with the ring finger.

Results Discussion Specific To Boxer's Fracture

Typically the patient will note loss of 5th Knuckle and X-Ray results may not always project perfect alignment to get an excellent outcome. As mentioned above, "fracture callus" may appear as a bony lump and is part of the normal healing process. You may notice a drooping of the small finger which should ultimately straighten in about 2 months. Expect aching in the hand for up to 3 months after complete healing has occurred. If loss of alignment is noted, it may require additional treatment to achieve the desired result.

For more information on how the wrist boxers fracture specialists at Cary Orthopaedics can help you, contact us today at 919-467-4992 for an appointment!

Cary Orthopaedics serves patients from Raleigh, Garner, Cary, Apex, Holly Springs, Fuquay-Varina, Clayton, Chapel Hill, and Pittsboro, NC