In this episode, we discuss Boxer's fractures and how to best manage them in the ED.


https://media.blubrry.com/coreem/content.blubrry.com/coreem/Boxer_s_Fracture_eq.m4a



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Tags: Orthopedics, Trauma





Podcast Video
https://youtu.be/UreET5eLHas
Show Notes
Background:

40% of all hand fractures
A metacarpal fracture can occur at any point along the bone (head, neck, shaft, or base)
“Boxer’s” fractures classically at neck
Most common mechanism: direct axial load with a clenched fist
Most common metacarpal injured is the 5th
A majority of these injuries are isolated injuries, closed and stable

Examination:

Ensure that this is an isolated injury
May note a loss of knuckle contour or shortening
A thorough evaluation of the skin is important

Patients may also have fight bites and require irrigation and antibiotics


Tender along the dorsum of the affected metacarpal
Evaluate the range of motion as the commonly seen shortening results in extension lag

For every 2 mm of shortening there is going to be a 7 degree decrease in ability to extend the joint


Check rotational alignment of digits with the MCP and PIP at 50% flexion.

Partially clench their fist and ensure that the axis of each digit converges near the scaphoid pole / mid wrist




Deformity is often seen due to the imbalance of volar and dorsal forces

Dorsal angulation


AP, lateral and oblique views should be obtained on XR
The degree of angulation is estimated with the lateral view

NB: Normal angle between the metacarpal head...