Reviewer: S. Randhawa, M.D.
This one is fairly straightforward:
A 17-year-old male comes to the clinic on a Friday afternoon, complaining of pain and swelling along the outer aspect of his right hand.
It seems that earlier that week, he had gotten into an argument with his girlfriend and, out of frustration, punched the wall.
X-rays were obtained.
Boxer's fracture; the annotated x-ray (click to enlarge the images).
What is the diagnosis?
Boxer’s fracture is a break in the neck of the fifth metacarpal. I see 2-3 boxer’s fractures a year, almost always from guys punching a wall or a home appliance (and losing).
The text and images are courtesy of Dr. Scott from Politedissent.com and are used with permission.
A 28-year-old African American male (AAM) came to ER after punching a wall because he felt anxious. He complains of (c/o) swollen right hand. No hallucinations, delusions or suicidal ideas.
Past medical history (PMH)
Vital signs stable (VSS).
Extremities: edema over the dorsum of the right hand with tenderness over the 5th metacarpal, the extremity pulses are equal and symmetric.
X-ray of right hand: 5th metacarpal fracture with angulation.
Boxer's fracture (click to enlarge the images).
X-ray report: There is a fracture of the neck of the fifth metacarpal with adjacent soft tissue swelling. There is radial and palmar angulation of the distal fracture fragment. Additional fractures are not seen. Joint spaces are maintained.
A plastic surgeon was consulted and a reduction with splint was applied. The patient's hand neurovascular status was intact pre- and post-reduction.
Repeat films will be obtained in the morning.
Right 5th metacarpal fracture. Experienced boxers rarely sustain this type of fracture and the term "boxer's fracture" is a bit of a misnomer.
Metacarpal fractures are common injuries that account for 30-40% of all hand fractures.
Metacarpal neck fractures are the most common and are usually due to direct trauma. They most often involve the 5th and, to a lesser degree, the 4th metacarpal neck. Fractures of the 5th metacarpal neck ("boxer's fractures") account for approximately 10% of all hand fractures.
Metacarpal neck fractures. UpToDate, 2009.
Name that diagnosis. Politedissent.com.
Lover, not a fighter? | Life in the Fast Lane, 2010.