Boxer’s fracture: Physiotherapy Techniques for Rehabilitation

A boxer fracture is a specific type of fracture that occurs in fifth metacarpal bone, usually occur in the dominant hand. Hand fractures are the most common types of fractures, and metacarpal fractures occurs around 18–44% of all hand fractures. It is more common in males than in females, and occurs at the age group of 10-29 years.

Open vs. Closed Boxer’s Fracture

Causes of Boxer’s Fracture

• Punching - during sports activities like boxing, martial arts etc.
• Falling onto an outstretched hand
• Sports Injuries - involving hand-to-hand combat, such as rugby, football, or wrestling
• Traumatic incidents such as car accidents, bicycle accidents, or workplace injuries where the hand sustains direct trauma
• Repetitive Stress - such as heavy lifting, manual labor, or repetitive motions involving the hand and wrist

 

Symptoms of Boxer’s Fracture

• Sharp or dull pain in the hand, specifically around the site of the fracture
• Swelling particularly near the knuckle of the affected finger
• Bruising may develop rapidly or over time following the injury
• Misalignment of the finger
• Localized tenderness when pressure is applied to the fractured bone
• Limited Range of Motion especially during grasping certain objects
• Numbness or Tingling
• Weakness
• Inflammation around the site of fracture

 

Diagnosing Boxer’s Fracture 

Physical Examination:

The physiotherapist conducts a thorough physical examination of the hand, focusing on the affected finger and surrounding structures. It includes:

• signs of swelling
• bruising
• deformity
• tenderness
• breaks in the skin (fight bites)
• neurovascular status
• pseudo clawing
• comparison with uninjured hand

Pain Assessment:

The patient's pain level and specific areas of tenderness is evaluated. Pain elicited upon palpation of the affected metacarpal bone or movement of the injured finger, can be indicative of a fracture.

X-ray Imaging:

X-ray imaging of the hand is the gold standard diagnostic tool for confirming the presence of a boxer's fracture and assessing its severity. Anteroposterior (AP), transverse and lateral views of the hand are typically obtained to visualize the fracture site and determine the extent of displacement or angulation, which is 15 degrees normally.

Fracture Classification:

Based on the X-ray findings, the fracture is classified according to its location, degree of displacement, and involvement of adjacent structures i.e., open or closed, intra-articular or extra-articular, oblique, spiral, transverse, or comminute.

Assessment of Soft Tissues:

In addition to assessing the bone, the physiotherapist evaluates the soft tissues surrounding the fracture site for signs of injury, such as skin lacerations, abrasions, or contusions.

Differential Diagnosis of Boxer’s Fracture 

 

Physiotherapy Management of Boxer’s Fracture 

Boxer Fracture Splint

Initially, the fractured hand is immobilized with a splint or cast to protect the fracture and allow for proper healing. Conventional teachings suggest that the position of the hand for fracture splinting should be: the wrist extended at 20 degrees, 60-70 degree of flexion at the metacarpophalangeal (MCP), and interphalangeal joints in extension. Most commonly ulnar gutter splint is used.

Pain Management:

Physiotherapist often begins with pain management techniques such as Cryotherapy to reduce pain and inflammation in the hand and wrist.

Range of Motion Exercises:

Once pain and swelling have decreased, the physiotherapist introduce gentle range of motion exercises to prevent stiffness and maintain flexibility in the fingers, hand, and wrist. These exercises include 

• finger flexion and extension 
• wrist flexion and extension
• Radial deviation 
• Ulnar deviation 
• Pronation 
• Supination 

Strength Training:

As healing progresses, the focus shifts to strengthening exercises to rebuild muscle strength and improve grip strength in the hand and wrist. Progressive resistance exercises using hand therapy putty, thera bands, or specialized hand strengthening devices is prescribed.

Functional Activities: 

Physiotherapist also involves functional activities and exercises tailored to the individual's specific needs and goals. These may include activities to improve hand coordination and fine motor skills, such as picking up small objects, gripping, and manipulating objects of various shapes and sizes.

Focus is also placed on strengthening of rotator cuff muscles, along with wrist and elbow to improve stability.

Proprioceptive and Balance Training: 

Balance and proprioception exercises may be included to improve coordination and stability in the hand and wrist, reducing the risk of re-injury. These exercises may involve activities that challenge balance and coordination, such as using a therapy ball or foam pad.

Frequently Asked Questions

What are possible complications of a boxer’s fracture?

• Malunion
• Nonunion
• Infection
• Stiffness and Decreased Range of Motion
• Nerve Damage 
• Vascular Injury
• Complex Regional Pain Syndrome (CRPS)

Plus the patient can experience long-term functional impairment, affecting his ability to perform daily activities and tasks that require manual dexterity.

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

• Ensure proper punching technique with the wrist aligned straight and the hand properly positioned to minimize the risk of injury.
• Wear appropriate protective gear such as boxing gloves or hand wraps to cushion the impact and provide support to the hand and wrist.
• Maintain good hand and wrist strength through regular strength and conditioning exercises to improve bone density and muscle support.
• Always warm up before engaging in boxing or any other physical activity and incorporate stretching exercises to improve flexibility and reduce the risk of injury.
• Gradually increase the intensity and duration of training sessions to allow the hand and wrist to adapt to the demands of boxing without overstressing the bones and tissues.
• Avoid overexertion and listen to your body's signals to prevent fatigue and reduce the risk of injury due to compromised technique or muscle fatigue.
• Maintain a balanced diet rich in calcium, vitamin D, and other nutrients essential for bone health to support bone strength and resilience.

 

What happens if boxer's fracture is left untreated?

• persistent pain and discomfort in the hand and wrist
• reduced range of motion in the fingers, hand, and wrist may occur, limiting functional abilities
• loss of grip strength
• malunion or nonunion
• damage to surrounding nerves and blood vessels, leading to sensory deficits
• accelerate the development of arthritis in the hand and wrist joints
• increase risk of re-injury

What is Displaced boxer’s fractures?

A displaced boxer's fracture occurs when the fractured ends of the metacarpal bone in the hand are not properly aligned, resulting in a visible deformity or misalignment of the affected finger or hand.