A Boxer’s fifth metacarpal fracture typically results from a punch against a solid object. A careful examination of the skin and soft tissue is mandatory, and any laceration should raise suspicion for a human bite (fight bite). In addition, clinical examination of finger cascade and evaluation for a rotational deformity are critical. Although there is mixed literature to support this, classic teaching is that up to 40 degrees of volar angulation does not require reduction. Fractures with greater angulation or a rotational deformity should have a reduction prior to splinting. Splinting is typically an ulnar gutter with the fourth and fifth 90 degrees of flexion at the PIP; however, buddy taping and padding may be appropriate. Consider psychiatric support/anger management if appropriate.

 

anger management