Boxer's fracture
| Bar Room fracture | |
|---|---|
| Synonyms | scrapper's fracture, bar room fracture |
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| DP (PA) right hand x-ray showing fracture at the neck of fourth metacarpal bone | |
| Classification and external resources | |
| Specialty | emergency medicine |
| ICD-10 | S62.3 |
| eMedicine | aaem/53 |
Boxer's Fracture is a colloquial term for a fracture of one of the metacarpal bones of the hand. Classically, the fracture occurs transversely across the neck of the bone, after the patient strikes an object with a closed fist. Alternate terms include scrapper's fracture or bar room fracture.
As these are colloquial terms, texts and medical dictionaries do not universally agree on precise meanings. Various authorities state that a "Boxer's fracture" means a break in specifically the second metacarpal bone or third metacarpal bone, with "Bar Room fracture" being specific to the fourth metacarpal bone or fifth metacarpal bone. Though some writers assert that Boxer's fracture and Bar Room fracture are distinct terms representing injuries to different bones, this distinction seems to have been lost over time and most medical professionals now describe any metacarpal fracture as a "Boxer's Fracture" .
The symptoms are pain and tenderness in the specific location of the hand, which corresponds to the metacarpal bone around the knuckle. When a fracture occurs, there may be a snapping or popping sensation. There will be swelling of the hand along with discoloration or bruising in the affected area. Abrasions or lacerations of the hand are also likely to occur. The respective finger may be misaligned, and movement of that finger may be limited and painful.
Metacarpal fractures are usually caused by the impact of a clenched fist with a hard, immovable object, such as a skull or a wall, using improper punching technique. When a punch impacts with improper form, the force occurs at an angle towards the palm, creating a dorsal bend in the bone, ultimately causing the fracture when the bone is bent too far.
When a boxer punches with proper form, the knuckles of the second and third metacarpal align linearly with the articulating radius, followed linearly by the humerus. Due to the linear articulation of bones, the force is able to travel freely across these joints and bones and be dissipated without injury. Therefore, fractures of the second or third metacarpals are rare, with fractures of the 4th and 5th metacarpals comprising the vast majority of metacarpal fractures.
Diagnosis by a doctor’s examination is the most common, often confirmed by x-rays. X-ray is used to display the fracture and the angulations of the fracture. A CT scan may be done in very rare cases to provide a more detailed picture.
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