A review of a bread & butter presentation based on a young man I saw last week who was vague about how his injury occured.

Boxer's fractures are fractures of the 5th metacarpal neck, and typically occur from hitting something with a clenched fist.

Along with the usual neurovascular exam, check for rotational deformity.

Fingers are normally parallel went hand closed

 VS,

Small finger rotated or overlapping ring finger. Compare to other hand if needed.

No rotational deformity is acceptable

Reduce the fracture if there is a lot of angulation- numbers vary but generally > 40% = reduction. Function will be likely OK with more angulation but will have odd looking knuckles and a lump in palm.

    About 45 degrees

Reduction- pain control with hematoma or ulnar block, or procedural sedation.

For successful reduction, flex the MCP to 90. Then push on the bent finger to reduce the metacarpal head while keeping pressure on the metacarpal shaft.

Apply an ulnar gutter splint with 4th and 5th fingers bent to 70-90 degrees. Buddy taping the 4th and 5th fingers together provides rotational stabilization.