23 yo male presents with hand pain.  He reluctantly admits to punching a wall during a fight with his girlfriend.  Exam reveals focal swelling and tenderness of right hand.  What's the diagnosis?  (scroll down for answer)

Answer: Boxer's Fracture 

• Metacarpal neck fracture with volar displacement
• A common fracture of the 4th or 5th metacarpal after punching a hard object
• Angulation over 30 degrees requires reduction
• Immobilization requires buddy taping 4th and 5th digits and padding, and placing in an ulnar gutter splint with flexion at the MCP joint
• Be sure to look for "fight bights" or abrasions over the MCP joints, which indicate need for antibiotics to cover human oral flora as well as skin flora - use amoxicillin/clavulanate as first line for infection prophylaxis, and then take the opportunity to counsel your patient on violence