Boxer's Fracture * Occurs in the 5th metacarpal. Etiology * The cause of metacarpal fractures is commonly a direct axial force (any force that directly acts on the center axis of an object) or a compressive force (such as being stepped on). *Fractures of the 5th metacarpal are associated with boxing and the martial arts and are usually called a Boxers Fracture. Signs and Symptoms *The patient complains of pain and swelling. *Injury may appear to be an angular or rotational deformity. Special Tests A common test that AT’s use to look for a boxer’s fracture is they look for a “dropped knuckle”. *When the patient makes a fist and hold their arm straight out in front, you can look for a knuckle to be lower than the rest. Management *Initially, RICE and analgesics (pain relievers) are given, followed by X-ray examinations. *Deformity is reduced, followed by splinting. *A splint is worn for 4 weeks, after which early ROM is carried out. Next Steps Follow-up *A person with a boxer's fracture frequently is advised to follow-up with a bone specialist (orthopedic surgeon) or a hand specialist to ensure that the broken bone mends properly. *Follow-up should occur within 1 week of the initial injury if there is not a critical amount of angulations. Surgical *In rare but severe cases, a surgical procedure may be necessary to help stabilize the fracture. *Surgery typically involves using pins that pass through the skin and into the bones to hold the bones in place while healing occurs. Rehab *After four to six weeks in the cast or splint, adequate healing should have occurred so that you may start physical therapy to rehabilitate your injury. *The initial focus of physical therapy is to counteract the effects of being immobilized while the fracture healed. Some impairments that you may experience include: ›Loss of range of motion ›Loss of strength ›Swelling ›Pain *Electrical stimulation may be used to treat pain and swelling. *Massage and soft tissue techniques may help to improve mobility of the skin, muscles, and tendons around the wrist and hand. *Exercise should be a main component of your physical therapy program following a boxer's fracture. *Your fracture should be healed and normal function should be restored about 10 to 12 weeks after the initial injury.