A fracture of the neck of the fifth metacarpal bone is relatively common and referred to as a boxer fracture.
Risk factors:
(1) striking someone or something with a clenched fist (boxers may develop fractures in other metacarpals as well)
(2) intoxication or drug abuse (associated with a greater likelihood of getting into a fight and continuing to fight despite injury)
Features:
(1) The fracture is usually transverse.
(2) There is usually minimal comminution.
(3) The distal fragment is often displaced with dorsal angulation, towards the palm.
Complications:
(1) imbalance of the extrinsic tendons, resulting in a claw deformity
(2) rotation of the distal fragment which can interfere with the grip
(3) synovitis
(4) collateral ligament injury
(5) capsular tear
(6) damage to the sagittal bands of the extensor hood ("boxer knuckle")
The angle of palmar displacement in a lateral radiograph is used to determine if reduction is needed. Some use > 30° while others use > 50° as the decision point for intervention.
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