Boxer’s Fracture

Boxer’s Fracture

What is a boxer’s fracture?

A boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand. It gets its name because the injury is common in inexperienced boxers.

The metacarpal bones are the intermediate bones of the hand found inside the flat of the hand. They connect the bones of the fingers (the phalanges) to the bones of the wrist (the carpals). The fifth metacarpal is the metacarpal of the fifth (pinky) finger. The neck of the metacarpal bone is where the main shaft of the bone starts to widen outwards towards the knuckle.

Boxers are not the only people who can get a boxer’s fracture, but usually the injury results from direct injury to a clenched fist. The force fractures the neck of the metacarpal bone below the pinky.

Your doctor will need to distinguish boxer’s fractures from other metacarpal fractures, which break the shaft of the metacarpal, or fractures of the base of the small finger. These injuries may need different treatments.

Metacarpal bones, in general, are some of the most commonly fractured bones in the hands. A large percentage of these qualify as “boxer’s fractures.”

What causes a boxer’s fracture?

Usually, a boxer’s fracture happens when you punch a wall or another solid object at a high speed. You also might get a boxer’s fracture if you fall hard on your closed fist. The neck of the metacarpal bone is its weakest point, so it tends to fracture here.

What are the symptoms of a boxer’s fracture?

Symptoms of a boxer’s fracture can include:

  • Painful bruising and swelling of the back and front of the hand
  • Tenderness of the back of the hand in the region of the fractured fifth metacarpal
  • Bent, “claw-like” pinky finger that appears out of alignment
  • Limited range of motion of the hand and of the fourth and fifth fingers

Your knuckle may also not have its normal bumpy shape. Your symptoms may vary in severity depending on the complexity of your fracture. You might have only mild pain, or the pain might be more severe.

How is a boxer’s fracture diagnosed?

Your doctor will ask you about your symptoms, how you injured the hand, and your past medical problems. Your doctor will also examine your hand carefully, checking for tenderness, strength, misalignment, range of motion, breaks in the skin, and other features.

An X-ray of the hand can clearly confirm a boxer’s fracture.

How is a boxer’s fracture treated?

Your treatment depends on how severe the fracture is. Initial treatment might include:

  • Washing any cuts that are present in the skin
  • Getting a tetanus shot if you have a cut and haven’t had a shot for several years
  • Resting your hand for a few days
  • Keeping your hand above the level of your heart for a few days
  • Icing your injury several times a day
  • Taking pain medicine (prescription or over-the-counter)
  • Wearing a splint for several weeks

Before your doctor puts your hand into a splint, he or she may need to put your bones back into alignment. Usually, you’ll receive a local anesthetic to keep you from feeling any pain, and your doctor will physically manipulate the bones back into place. In some cases, your doctor might have to open up your hand surgically to get the bones back into alignment.

You also may need to work with a physical therapist for a while as your fracture heals. You’ll learn exercises to strengthen the muscles of your hand and keep them from getting stiff.

If you have an unusually severe boxer’s fracture, you may need immediate and more complicated surgery. For example, if your bone has broken through the skin, or if it has broken in several places, you will probably need surgery. You might also need surgery if you have a job or significant hobby that requires a lot of fine-motor movement of the hand, like playing the piano.

Even if you don’t need surgery right away, you might need it at some point. If your hand doesn’t heal as well as expected, surgery might be an option.

What are the complications of a boxer’s fracture?

An untreated boxer’s fracture can lead to a decrease in your ability to grip, limited range of motion of the finger, and an abnormal looking finger. With proper treatment, these complications are usually minor, if present at all.

What can I do to prevent a boxer’s fracture?

Avoid fistfights and punching solid objects to prevent many cases of boxer’s fracture. If you box, make sure you use the correct technique and the proper equipment.

How to manage a boxer’s fracture

Your doctor may give you some instructions about how to manage your boxer’s fracture, such as:

  • Keep your bones strong by eating a healthy diet with enough vitamin D, calcium, and protein
  • Stopping smoking, to help your fracture heal more quickly
  • Keeping your splint from getting wet

Your hand will be very easy to reinjure for 4 to 6 weeks after your splint is gone. You may need to use a hand brace if you return to contact sports during this time. Talk with your doctor about what makes sense for you.

When should I call my healthcare provider?

Call your doctor if:

  • You have numbness or tingling in your fingers
  • You fingers look blue
  • You have severe pain or worsening swelling
  • Your splint gets damaged and you need a new one

Key Points

A boxer’s fracture is a break in the neck of the fifth metacarpal bone in the hand. It usually happens when you punch an object at a high speed.

  • Symptoms of a boxer’s fracture include pain and swelling of the hand, limited range of motion of the pinky finger, and misalignment of the finger.
  • Your doctor can diagnose your boxer’s fracture with a medical history, physical exam, and X-ray.
  • You might need treatment with simple rest, ice, pain medicine, and splinting.
  • You might need surgery for your injury if it is severe.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Don’t Delay Hip Fracture Surgery. Here’s Why

Don’t Delay Hip Fracture Surgery. Here’s Why

Seniors with a fractured hip need surgery as soon as possible or they could suffer life-threatening complications, a new Canadian study concludes.

Having surgery within 24 hours decreases the risk of hip fracture-related death. It also lowers odds of problems such as pneumonia, heart attack and blocked arteries, the researchers found.

“We found that there appears to be a safe window, within the first 24 hours,” said lead researcher Daniel Pincus, a doctoral student with the University of Toronto.

“After 24 hours, risk began to clearly increase,” Pincus said.

U.S. and Canadian guidelines recommend hip fracture surgery within 48 hours of injury, but it’s likely that many people don’t receive care that quickly, he noted.

In the United Kingdom, guidelines call for surgery within 36 hours, but hospitals often fail to get patients promptly into the operating room, Pincus added. Rates range from 15 percent to 95 percent among U.K. hospitals, according to the report.

Oftentimes, there’s no operating room or surgeon available, or other patients are awaiting surgery, Pincus explained.

“There’s a triage system and these patients historically were not prioritized,” he said. “Sometimes there’s medical reason for the delay, but that’s very rare. We’re starting to realize there’s almost no reason why a patient should be delayed.”

Delay also likely occurs because doctors approach these elderly patients with a good deal of caution, said Dr. Harry Sax. He is executive vice chair of surgery for Cedars-Sinai Medical Center in Los Angeles.

“The perception is that if you’re old and you’ve broken your hip, that you’re going to have a lot of other [health problems],” said Sax, co-author of an editorial accompanying the new study. “Therefore, I need to spend several days running tests on you to try to make sure I can get you through the hip fracture surgery. ”

To see how this delay affects the health of patients, Pincus and his colleagues evaluated data on over 42,000 people treated for hip fracture at 72 hospitals in Ontario between April 2009 and March 2014. The patients’ average age was 80.

The investigators compared patients based on whether they had surgery before or after 24 hours.

Overall, about 12 percent of hip fracture patients died within the month following their surgery.

However, patients who got surgery within 24 hours were 21 percent less likely to die during the following month, compared with those who had a delay in surgery, the findings showed.

Those patients also had lower complication rates. They were 82 percent less likely to develop a blood clot in the leg veins (deep vein thrombosis); 61 percent less likely to have a heart attack; and 49 percent less likely to suffer a blood clot in the lung (pulmonary embolism). They were also 5 percent less likely to develop pneumonia during the month following surgery.

“The problem is the longer you sit in bed, the more likely you are to get pneumonia and blood clots. The unfixed bone is continuing to flick off little bits of fat, which can go to the lungs,” Sax said. “The delay doesn’t necessarily make things better. It could make things worse.”

People with an elderly relative facing hip fracture surgery should ask the health care team to get their loved one into surgery as soon as possible, with as little additional testing as possible, Pincus and Sax said.

“A prompt evaluation to make sure there’s nothing quickly correctable should be done, but otherwise the patient should move to the operating room as quickly as possible,” Sax said.

Families should ask doctors about every test, scan or screen that delays the surgery, Sax said.

“The question needs to be, what is the information that you’re going to gain and how would that change your management of this patient,” Sax said. “There are very few things you find with all this expensive testing that you can do anything about.”

The patient would be best off in a hospital that has a specific program to manage elderly people with hip fractures, Sax added. These programs have a team of surgeons, geriatricians, anesthesiologists and other professionals well-versed in the procedure.

“If you can find a hospital that does that, the chances are your outcomes are going to be better,” Sax said.

The study was published Nov. 28 in the Journal of the American Medical Association.

More information

For more on hip fractures, visit the American Academy of Orthopaedic Surgeons.

SOURCES: Daniel Pincus, doctoral student, University of Toronto, Ontario, Canada; Harry Sax, M.D., executive vice chair, surgery, Cedars-Sinai Medical Center, Los Angeles; Nov. 28, 2017, Journal of the American Medical Association

Ditch the Throw Rugs, Seniors!

Ditch the Throw Rugs, Seniors!

Icy winter weather may lead to fewer hip fractures than many believe.

Most fall-related hip fractures among elderly people in a New England study occurred in warm months and indoors — with throw rugs a common culprit.

“Given the results of this study, it appears that efforts to decrease fall risk among the elderly living in cold climates should not be preferentially aimed at preventing outdoor fractures in winter,” said study author Dr. Jason Guercio.

Instead, preventive efforts should focus on conditions present year-round, and especially on indoor risk, said Guercio. He’s with North American Partners in Anesthesiology at the Hospital of Central Connecticut in New Britain, Conn.

The researchers analyzed details about hip fractures suffered by 544 patients treated at the Hospital of Central Connecticut between 2013 and 2016.

More than 55 percent of the hip fractures occurred during warm months, with the highest rates in May, September and October (around 10 percent each). In addition, the investigators found that more than three-quarters of the hip fractures occurred indoors.

Moreover, 60 percent of outdoor fractures occurred from May through October, not in the depths of winter.

The most common cause of both indoor and outdoor hip fracture? Tripping over an obstacle. Indoors, throw rugs were the most common obstacle cited.

Falling out of bed was the second leading cause of indoor hip fractures.

Outdoors, the other leading causes of hip fractures were being struck by a vehicle or falling from a vehicle, followed by accidents on stairs.

The study was scheduled for presentation Monday at the annual meeting of the American Society of Anesthesiologists, in Boston.

“Falls are one of the most common health concerns facing the elderly today. And this population is the fastest growing segment of the U.S.,” Guercio said in a meeting news release.

“Falls leading to fracture can result in disability and even death. Understanding the risk factors for fractures can help to focus efforts on decreasing them, and guide resources and appropriate interventions to prevent them,” Guercio said.

“It is counterintuitive that the risk for hip fracture would be higher in warm months, as ice and snow would appear to be significant fall risks,” he added.

Research presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.

More information

The U.S. Centers for Disease Control and Prevention has more on hip fractures among older adults.

SOURCE: Anesthesiology annual meeting, news release, Oct. 23, 2017

Sports Injuries: Kneecap (Patellar) Dislocation

Sports Injuries: Kneecap (Patellar) Dislocation

Athletes in high impact sports or sports that require a lot of running and jumping are prone to knee injuries.  kneecap dislocations most often happen as a result of trauma, such as when a football player is tackled, or a soccer players falls hard on his knees.

The kneecap, or patella, is referred to as dislocated when it slips out of the groove in the femur (thigh bone) that is naturally sits in. Some patients recover from a dislocation and never experience the condition again. For other patients, however, the patella will chronically dislocate until it is repaired through surgery.

You’ll know you’ve dislocated your knee cap if you feel these symptoms following an incident:

  • Severe pain at the knee
  • Redness and swelling
  • Deformity
  • Difficulty moving the knee at all

While many patients can overcome a patellar dislocation with a physical therapy regimen, severe cases will require surgery.

If the surrounding cartilage and bone are not severely damaged, five to six weeks of rehabilitation should be sufficient.   This includes strengthening exercises designed to rebuild the muscles surrounding the patella, which also will in-turn restore the range of motion that should be enough to recover from the injury.

If surgery is required, an orthopedic knee specialist will reset the kneecap and perform a short arthroscopic procedure to remove any dislodged pieces of bone, and smooth down any damaged cartilage. As with most sports injuries, surgery will also require 6 to 8 weeks of rehabilitation for proper healing.

Dr. Main and Dr. Pick-Jacobs treat athletes with mild to severe patella issues routinely. Dr. Main is an expert in arthroscopic surgery to repair the knee following even the most severe cases of kneecap dislocation.

Do Your Knees Crackle and Pop?

Do Your Knees Crackle and Pop?

Knees that “pop,” “click” or “crackle” may sometimes be headed toward arthritis in the near future, a new study suggests.

It’s common for the knees to get a little noisy on occasion, and hearing a “crack” during your yoga class is probably not something to worry about, experts say.

But in the new study, middle-aged and older adults who said their knees often crackled were more likely to develop arthritis symptoms in the next year.

Of those who complained their knees were “always” noisy, 11 percent developed knee arthritis symptoms within a year. That compared with 4.5 percent of people who said their knees “never” popped or cracked.

Everyone else fell into the middle. Of people who said their knees “sometimes” or “often” made noise, roughly 8 percent developed knee arthritis symptoms in the next year.

Doctors have a term for those joint noises: crepitus.

Patients commonly complain of it, said Dr. Grace Lo, the lead researcher on the study. She’s an assistant professor at Baylor College of Medicine in Houston.

But until now, it hasn’t been clear whether crepitus can predict symptomatic knee arthritis. That means people not only have evidence of cartilage breakdown on X-rays, but also suffer symptoms from it — namely, frequent pain and stiffness.

“Our study suggests crepitus is not completely benign,” Lo said. “It’s a sign that something is going on in the knee joint.”

Dr. Joseph Bosco, an orthopedic surgeon who wasn’t involved in the study, agreed that frequent crepitus should be checked out.

“A lot of people’s knees ‘snap’ and ‘pop,'” said Bosco, a professor at NYU Langone Medical Center in New York City. “Do they need to run out for knee replacements? No.”

But, he added, “if you experience crepitus regularly, get an evaluation.”

The findings, published May 4 in the journal Arthritis Care & Research, come with some caveats.

The nearly 3,500 study participants were at increased risk of developing knee arthritis symptoms to begin with, Lo explained.

The participants ranged in age from 45 to 79. Some were at risk of knee arthritis simply because of old age, while others had risk factors such as obesity or a history of a significant knee injury.

So it’s not clear, Lo said, whether the findings would translate to — for example — a 35-year-old whose knees crack when she runs.

Plus, even though the study participants were initially free of knee arthritis symptoms, some did have signs of arthritis damage on an X-ray.

And it was in that group where crepitus was a red flag: People who “often” or “always” had noisy knees were nearly three times more likely to develop knee arthritis symptoms as those who “never” had crepitus.

According to Lo, the findings could be useful in everyday medical practice. “If patients are complaining of frequent cracking or popping in the knees,” she said, “get an X-ray.”

If that turns up signs of arthritic damage, Lo said, then the risk of progressing to symptoms in the near future is probably significant.

Unfortunately, there is no magic pill that can stop arthritis in progress. But, Lo said, for patients who are heavy, weight loss can help.

Some, she added, might benefit from strengthening the muscles that support the knees.

Seniors Get Good Results From Herniated Disc Surgery

Seniors Get Good Results From Herniated Disc Surgery

People over age 65 shouldn’t avoid surgery for a herniated disc just because of their age. Seniors benefit from the procedure as much as younger patients, Norwegian research shows.

The study involved more than 5,500 people with a herniated, or “slipped” disc. The condition occurs when one of the discs that cushions bones in the spine gets damaged, causing it to push forward. The result is lower back pain that can extend to the leg and foot, and even lead to paralysis.

Exercise, heat and pain medication provide relief in some cases. But people with severe pain or disability may need surgery, according to researchers at St. Olav’s Hospital in Trondheim, Norway and the Norwegian University of Science and Technology (NTNU).

The investigators compared patient-reported outcomes after disc surgery. The study included nearly 5,200 patients under age 65, and about 380 older patients.

The researchers reported that older patients had less back pain after surgery than younger patients. But the seniors experienced more minor complications and had slightly longer hospital stays. However, the study authors said that these issues were not serious and didn’t affect the success of their treatment.

“This study shows that it is fully possible to do good surgical research on elderly patients,” study leader Mattis Madsbu said in a NTNU news release. Madsbu is a medical student at the university.

The study was published recently in JAMA Surgery.

More information

The U.S. National Library of Medicine has more about herniated discs.

SOURCE: The Norwegian University of Science and Technology, news release, May 2017