What's the Diagnosis? By Dr. Michael Tom

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