A young male presents with acute pain and swelling over the dorsal aspect of his hand after "punching a wall". 

Radiographs are below.

 

Diagnosis?

There is an acute fracture to the fifth metacarpal, which is more commonly known as a "boxer's fracture". It is usually caused by a direct blow to the hand (as in a punch), a rotational injury with axial loading, or high-impact trauma. Due to the mechanism, it is most commonly seen in males ages 15-29.

It is important to check for breaks in the overlying skin, because if is an associated laceration, also called a "fight bite", appropriate antibiotic coverage is needed. Tendon injuries can also be seen, so a full neurovascular exam must be done.

General treatment for closed, stable boxer's fractures is non-operative, with placement in an ulnar gutter splint for 4-6 weeks. Standard of care is Ortho follow-up within 7-10 days for repeat radiographs to evaluate for proper healing.

Operative treatment is indicated if, on radiographs, the shaft is angulated more than 40 degrees or shortened by more than 2-5mm. Angulation of the neck is tolerated up to 50-60 degrees before surgical intervention.