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What is a fracture of the 5th metacarpal?

The metacarpals are the hand bones leading up to your fingers. The 5th metacarpal leads to the little (5th) finger. This can sometimes be injured either at the neck (close to the knuckle), the shaft (the long bit of the bone), or the base (near the wrist). A fracture is a break in the bone (fracture and break mean the same thing).

Why is it called a boxer’s fracture?

The commonest cause of a fractured 5th metacarpal is a punch injury, which is why it is nicknamed a ‘boxer’s fracture’. However, it can sometimes be caused by falling on a closed fist.

How is it diagnosed?

The little finger side of the hand is usually swollen and painful. There may be a lump on the bone. The little finger may be slightly short compared to the other side. When making a fist, the knuckle of the little finger may not be the same as the other side. If the broken bone has twisted, the little finger may not form a normal fist.

An X-ray is used to see if the bone is broken and the extent of the break.

How will my injury be treated?

If the broken bone is not in any danger of moving, it is protected by strapping the little finger to the ring finger. This is called ‘neighbour strapping’ or ‘buddy strapping’. The strapping should be kept on for 2 to 3 weeks. You should not play any sport or rough games until the bone is strong, at about 5 weeks. You will not need to come back to clinic.

If there is a danger that the broken bit of bone will move, a cast is put on over the little finger from the tips of the fingers to the elbow. This holds the bones in place to help them heal. The cast is needed for 2 to 3 weeks. It will be removed when you come back to clinic. You should not play any sport or rough games for 5 to 6 weeks.

Sometimes antibiotics are given if the skin is broken over the injury, especially if the cut was made by someone’s teeth.

Pain relief such as paracetamol and ibuprofen can be given to help with the pain. More information about pain relief can be found here: Paracetamol and ibuprofen.

Will I need an operation?

If the bone is very bent or rotated then it will need straightening. This can usually be done with the help of local anaesthetic and ‘gas and air’ (nitrous oxide, also called ‘laughing gas’). Strapping and a plaster cast will be applied once the bone is straightened.

Very occasionally the break is too unstable to stay in the right place, even in a plaster cast. You will be referred to a doctor who specializes in bones (orthopaedic doctor) who may put wires or small screws in to keep the bone in place. This is an operation done under a general anaesthetic and you will need to come into hospital.

Are there any long term effects?

After this injury the finger is often very slightly shorter, and when you make a fist the knuckle is ‘dipped’. There may also be a small lump just below the knuckle, although this may disappear with time. This should not affect the ability to use the hand.

The hand will be stiff to start with, particularly if a cast or an operation is needed. Exercises can help restore strength and range of movement.

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Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

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