Fifth Metacarpal Fracture (Boxer's Fracture)

What is a fifth metacarpal fracture?

The metacarpals are the long bones in the hand. The fifth metacarpal is the bone in the hand that attaches to the pinky finger. A fracture is a break in the bone.

A child's bones are different than adults in some important ways. First, the bones of a child are more flexible. Sometimes the bones crack like green branches from a live tree instead of snapping like a dry stick. Other times the bones just buckle slightly. When this happens, the bone is broken but there isn't a clear fracture line just a slightly raised area on the outside of the bone. The second major difference is that a child's bones are still growing. Bones grow from an area near their ends called the growth plate. Sometimes fractures occur within the growth plate and can be difficult to see on an x-ray. Fractures in this area can affect the growth of the bone and may require special x-rays or other tests.

How does it occur?

A fifth metacarpal fracture usually occurs when your child hits a hard object with his or her fist. That is why it is also called a boxer's fracture. It can also occur if your child falls onto the hand.

What are the symptoms?

Symptoms include pain, swelling, and tenderness on the pinky finger side of the hand. There may be a bump on the side of your child's hand or it may look crooked.

How is it diagnosed?

Your child's health care provider will review the symptoms, ask how the injury happened, and look at the hand. Your child's provider will take an x-ray of the hand, which will show the break.

How is it treated?

If the broken bone is crooked your child's provider will straighten it. Then a cast or splint will be placed from the hand to the forearm. The cast or sling will need to stay on for 4 to 6 weeks.

Treatment will also include:

• Elevating your child's hand by placing it on a pillow during sleep or the back of a couch when sitting down.
• Putting an ice bag over the cast or splint for 20 to 30 minutes every 3 to 4 hours for the first 2 to 3 days.
• Taking anti-inflammatory medicine or other medicine prescribed by your child's provider.

Fifth metacarpal fractures usually heal within 6 weeks.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your child's activities will be determined by how soon the hand recovers, not by how many days or weeks it has been since the injury occurred. The goal is to return them to normal activities as soon as safely possible. If your child returns too soon the injury may get worse. Your child may start rehabilitation exercises when the health care provider has taken a follow-up x-ray sees that the fracture has healed.

Your child may return to normal activities when the hand has full range of motion without pain and has the same strength as the uninjured hand.