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Boxer’s fracture


Boxer’s fractures, often referred to as brawler’s fractures, are a specific kind of hand fracture that frequently happens when someone punches something hard with a closed fist. The hand’s metacarpal bones, notably the neck or head of the fourth or fifth metacarpal, are the main targets of this injury. In this blog post, we will delve into the definition, causes, epidemiology, and treatment options for Boxer’s fracture.


A fracture at the base of the fourth or fifth metacarpal, which connects the hand to the fingers, is referred to as a “boxer’s fracture.” It often happens when someone strikes something hard with a closed hand, putting too much pressure on the metacarpals.


Sagittal Band Tear “Boxer's Knuckle” - Hand and Wrist Institute


Punching a rigid object with a closed fist is the main cause of Boxer’s fracture. This could happen in a physical conflict, during a sporting event, or even as the consequence of an unintentional impact against a hard surface. The repetitive nature of boxing and martial arts training can also increase the risk of developing this fracture.


Due to their larger engagement in sports and violent altercations, men are more likely than women to get a boxer’s fracture. The dominant hand is more typically affected in young adults between the ages of 18 and 30, where the injury is frequently encountered. Rugby, boxing, mixed martial arts, and other contact sports participants are more prone to this kind of fracture.


Common signs of a Boxer’s fracture observed at the base of the damaged metacarpal bone:

  • Pain
  • Swelling
  • Soreness
  • Deformity

Additionally, the damaged hand may have bruises, restricted movement, and trouble gripping or grasping items. In extreme circumstances, the fracture may pierce the skin and become an open fracture.


A healthcare provider will do a physical examination of the hand and look for edema, deformity, and soreness in the afflicted area to determine whether Boxer’s fracture has occurred. X-rays are frequently used to confirm the diagnosis since they give clear pictures of the fracture and may be used to assess its severity and the placement of the broken pieces of bone.

Recovery and Prevention

The recovery time for Boxer’s fracture varies depending on the severity of the injury and the individual’s overall health. Generally, it takes approximately 6 to 8 weeks for the bones to heal, followed by a period of rehabilitation and gradual return to normal activities. It is crucial to follow the recommended treatment plan, attend follow-up appointments, and avoid any activities that may put excessive stress on the healing hand.

Prevention primarily involves using proper hand protection and technique during sports activities and avoiding physical altercations


The treatment of Boxer’s fracture depends on the severity of the injury. For stable fractures with minimal displacement, non-surgical interventions are often sufficient. The following treatment approaches may be employed:

  • Immobilization: The affected hand and wrist may be immobilized using a splint, cast, or buddy taping. This helps promote healing and prevents further injury.
  • Pain management: Over-the-counter pain medications or prescribed pain relievers may be recommended to alleviate discomfort during the healing process.
  • Ice and elevation: Applying ice packs to the injured hand and keeping it elevated above the heart level can help reduce swelling and pain.
  • Rehabilitation: Once the fracture has healed sufficiently, a healthcare professional may prescribe physical therapy exercises to restore hand strength, flexibility, and range of motion.

In cases where the fracture is unstable or significantly displaced, surgical intervention may be necessary. Surgery involves realigning the fractured bones and securing them with screws, pins, or plates to facilitate proper healing.

Physical therapy management

Physical therapy plays a vital role in the rehabilitation process for individuals recovering from a Boxer’s fracture. It aims to restore hand function, strength, and range of motion while minimizing pain and preventing complications. Here are some key aspects of physical therapy treatment for Boxer’s fracture:

  1. Initial Assessment: A physical therapist will assess the extent of the injury, evaluate the patient’s pain levels, and determine their functional limitations. This assessment helps create an individualized treatment plan tailored to the patient’s specific needs.
  2. Pain Management: If the patient experiences pain or inflammation, the physical therapist may use various techniques such as ice or heat therapy, or electrical stimulation to alleviate discomfort and reduce swelling.
  3. Range of Motion Exercises: Gentle exercises are initiated to restore joint mobility and prevent stiffness. These may include finger flexion and extension exercises, wrist movements, and gentle stretches for the hand and fingers.
  4. Strengthening Exercises: As the healing progresses, the physical therapist will introduce strengthening exercises to rebuild hand and grip strength. These exercises may involve squeezing a stress ball, using resistance bands, or performing specific hand and finger exercises
  5. Manual Therapy: Manual techniques such as soft tissue massage, joint mobilizations, and stretching may be employed by the physical therapist to improve tissue flexibility, increase blood flow, and enhance healing.
  6. Functional Training: Once the fracture has sufficiently healed, functional training exercises are incorporated to help the patient regain the ability to perform everyday activities. This may include tasks such as writing, buttoning clothes, grasping objects of different sizes, and other specific functional movements required for work or hobbies.
  7. Activity Modification and Education: The physical therapist will educate the patient on proper body mechanics, ergonomics, and techniques to prevent future injuries. They may also provide guidance on gradually returning to sports or activities that involve hand usage while emphasizing the importance of proper technique and protective measures.
  8. Home Exercise Program: To optimize recovery, the physical therapist will develop a personalized home exercise program that the patient can continue independently. Consistency in performing prescribed exercises and adhering to the recommended guidelines is essential for a successful rehabilitation outcome.



Boxer’s fracture, a specific type of hand fracture resulting from forceful punches with a closed fist, can cause pain, swelling, and functional limitations in the hand. Understanding the causes, epidemiology, and treatment options for Boxer’s fracture is essential for both prevention and effective management of this injury.

While Boxer’s fracture can be a challenging injury, with appropriate medical care, patience, and adherence to the recommended treatment plan, individuals can achieve a full recovery and regain their hand’s normal function. Remember, prevention is always better than treatment, so practicing proper hand protection and technique during activities can help minimize the risk of Boxer’s fracture and similar hand injuries.

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