From last months column on skiers thumb, I am moving to the other side of the hand and the subject of boxers fracture.
Straightaway, I have never seen a boxer with a boxers fracture probably the result of boxing gloves. Gone are the bare knuckles of decades, perhaps a century, ago. In any event, the fracture typically occurs when a clenched fist, usually the dominant hand, strikes a hard surface.
The usual recipe is a knucklehead, who liberally swilled alcohol, and a punch to a wall. Typically, the fifth metacarpal (sometimes with the fourth metacarpal) fractures through the neck or the shaft of the bone. The metacarpals are the bones from the base of the fingers to the wrist bones and are numbered one to five from the thumb to the little finger.
Boxers fracture is but one of many self-inflicted injuries that frequent emergency departments: razor and knife slashes of the forearms and wrists, gunshot wounds (often to the head, during the draft years occasionally the foot), and overdoses from prescription drugs, over-the-counter drugs and street drugs, to name a few. Impulsively punching a wall usually results in a trip to the ER after the alcohol has begun to wear off midnight or the wee hours.
It can be costly. Guesstimates are $500 for the ER and X-rays, thousands if the fracture is severe and needs surgical repair and stabilization, and possibly weeks of lost work. It is all about deformity/angulation (and/or rotation) of the metacarpal (knuckle) fragment. More than about 70 degrees of angulation and grip is affected, and surgical correction rather than simple splinting is necessary.
Perhaps we should be thankful that walls rather than people are the chosen targets. Punching a wall rarely results in cuts or puncture wounds to knuckles. If a cut or puncture is present, it is likely the result of contact with a tooth or teeth a punch in the mouth. Essentially human bites, these are dangerous wounds and serious infection often results, especially if unrecognized and untreated. Sometimes these midnight citizens will attempt to mislead: I guess I fell or some other bogus story. The presence of law enforcement in the ER may provide the true clue to what has happened.
One writer on the subject wrote that because boxer fracture is usually the result of anger, rage or frustration, the patient may have a problem with anger control.
Gee, really? To knucklehead plus alcohol, we need add only male and young. One study identified 92 percent of boxers fractures as occurring in males, the average age slightly older than 22. If the patients history is suggestive or positive for similar self-injury or accidents, interventions other than medical are appropriate.
Perhaps, the male preponderance or predilection for boxers fracture suggests that the female, gentler sex, and the XX chromosome configuration are superior to the male XY.
I have to agree. However, of the very few women I have seen with this injury, one was the absolute worst the hands-down winner. She had a compound boxers fracture with broken bone protruding from the back of her hand. What was she drinking? Answer: a lot.
www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.