Joe A Shaw PA-C - 4/9/2008

Question
My 17 yo son got into a fight three weeks ago, one punch was thrown. His hand swelled up, but never did he say anything about pain other than just aching. He took motrin for a day or two at my insistance. Two days ago, I noticed that he had a "knot" on top of his hand over the 5th metacarpal bone. The school trainer looked at it and told him she was almost certain it was broken. Upon her exam, she discovered he had pain radiating into his wrist. We took him to the local clinic last night. They discovered he has a boxers fracture of the 5th and the bone is displaced at a 35 degree angle with regrowth behind the bone. We are to see a hand specialist. We were wondering what we are looking at...the doc at the clinic indicated that since the break was three weeks old and had started to heal that surgery would be needed. I have the xrays available if you would like to see them. Thanks


Answer
V,
The most important thing they will look at is the angulation and if it is causing rotation of the little finger,say towards the ring finger. If the break was at the neck of the 5th metacarpal hand bone..ie just below the knuckle, then more angulation can be tolerated..some orthos say as much as 50% or more. If the break was at the base of the bone ie towards wrist area then less angulation can be tolerated. Also if the break was in the joint he will need surgery. Either way, He will always have a depression there at knuckle area.
I have attached a good and easy to understand article
 http://www.orthosports.com.au/hand_boxer.html