![]() ![]() In doing so, the knuckles (the heads of the metacarpals) strike directly against a hard object and all the force of the blow is transmitted directly through the metacarpals. This commonly occurs during a punch with a clenched fist. A Fracture of the 5th mettacarpal represents 10% of all hand fractures and is the most common bone to be injured when throwing a punch.Ī metacarpal fracture occurs when the hand strikes another object with sufficient force to cause the metacarpal bones to break. Metacarpal Fracture 5th Image Source WIKIPEDIAĪ Boxer’s fracture is a fracture of the 5th metacarpal neck (metacarpal bone of the littlefinger or pinky finger), in which direct trauma is applied to a clenched fist when it strikes another object. However other impact sports like football and rugby place the competitor’s hands at risk of impact against things like opposing players’ helmets and pads as well as the ground itself. Classically this occurs in boxers and other athletes involved in the martial arts. When this happens, often the injured finger will scissor under or above an adjacent finger.Ī metacarpal fracture can occur in any sport although the highest risk is in those sports where there is a risk of a high energy impact occurring to the athlete’s hand. If the finger corresponding to the fractured metacarpal does not line up properly with the surrounding fingers, then the fracture ends are most likely rotated. When they do so, the fingers should all line up properly and be parallel. This can be assessed by asking the patient to make a fist. One important aspect of the physical exam is whether there is a rotational deformity of the fracture. If the fracture becomes angled, then the hand may be bent inwards towards the palm some and there may be a point felt from the apex of the fracture. There may be palpable fracture ends of the bone which can be felt to move if pressed. On physical examination, the athlete’s hand will be most tender over the injured metacarpal. They may have difficulty moving the fingers due to the amount of pain from the fracture. There will be swelling, often a considerable amount, as well as bruising directly over the injury. Their hand will be very painful, maximally so over the specific metacarpal bone that is fractured. It will often be due to a punching injury or a direct blow from a fall or crush injury. The normal motion of the metacarpals can be seen when one makes a tight fist while watching the ring and small finger side of the back of the hand bend further inward.Īn injured athlete will describe a forceful blow to the hand. On the other hand, the index and long fingers’ have lesser ability to adapt to metacarpal fracture bending because they have less natural motion. This is because the increased normal motion of these two metacarpal bones can allow the hand to adapt to any permanent deformity. The increased motion at the two smaller fingers allows for more angulation to be acceptable as the fracture heals. In an athlete’s normal uninjured hand, there is less motion at the joints of the index and long finger and more motion at the ring and small fingers. A higher force injury can lead to more bending (displacement of the fracture). How much the fracture bends is somewhat dependant on how much force caused the injury in the first place. When a metacarpal fracture happens, the finger flexors and the intrinsic muscles act together to bend the fracture toward the palm (apex dorsal angulation). In between the metacarpal bones are the small intrinsic muscles (the interosseous and lumbrical muscles) that further help to control fine finger motion. There are extensor tendons on the back of the hand that act to extend or straighten the fingers. There are flexor tendons on the palm side of the metacarpals that act to flex, or bend the fingers as in making a fist. Each of the fingers (digits) has a corresponding metacarpal that links the wrist bones to the phalanges (individual bones of the fingers). The metacarpals are the tubular bones that comprise most of the space in the palm. For example Ronnie Brown of the Miami Dolphins and Tony Romo of the Dallas Cowboys each spent time on the IR from suffering a metacarpal fracture as did the Mavericks Jason Terry who had surgery to fix his metacarpal fracture. ![]() These injuries are also common in other sports besides boxing.
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