Mechanism of injury and on-site treatment
Boxer’s fracture occurs when the fist is clenched and a strong punch is thrown, resulting in fractures of the neck of the metacarpal bone. In general, the fractures occur most often in the fourth and fifth metacarpal bones. However, senior athletes, such as professional boxers and Karate practitioners, often get injured on the second and third metacarpal bones, so they need to be cautious in sports scenes. If a doctor confirms limitation of MP joint motion and loss (deformity) of a prominent metacarpal head or severe swelling of the metacarpal neck as acute symptoms, the doctor suspects fractures and treats the injuries.
On-site evaluation and first aid
First on-site treatment is icing. If there is deformity caused by the fractures, it is recommended to use ice bucket because compressing the region with ice packs or ice bags may be painful. At the time, the injured area should be elevated as much as possible with the ice bucket positioned in high level. Also, doing icing on the whole hand by dipping the hand getting to the position of wrist in the bucket. Once the hand becomes numb in 20 minutes, the area needs to be immobilized.
Fixation is performed using a splint with sponge attached to a metal plate (Photo 2). As the splint may be easily deformed by hand, it provides firm fixation on the injured area. The splint is very useful in the first-aid treatment at the sports scene.
The splint is placed on the volar side and taped around the wrist and DIP joint. The MP joint is fixed in a slightly flexed position. Once fixation is done, the patient has to seek medical attention immediately.
For conservative treatment, the injured area is immobilized for 3 to 4 weeks after reduction at the medical institution.
After fixation, athletic rehabilitation is provided for the purpose of restoring range of motion and muscle strength. An introduction of an athletic rehabilitation program is introduced as follows.
Massage of the back of the hand
Initially, physical therapy such as warm bath method and hot pack is provided, followed by passive approaches to massage or exert traction on to improve joint contractures.
Kneading the area between metacarpals with thumb
Kneading the finger with two-finger
Improvement of Joint Range of Motion by the hand
Next, active exercises and strength training are performed, and try to move the affected area actively. The decision to return to competition is made by reviewing the condition of synostosis and recovery of joint function.
Active exercise with buddy tape
By using buddy tapes, the injured finger may be exercised simultaneously with the movement of approximal finger.
Flexion of MP, PIP and DIP joint
Extension of MP, PIP and DIP joint
Finger abduction with rubber band as a load
Holding by pulling on elastic bandage or towel in hand