Overview
what it is and why it mattersMetacarpal fractures — breaks in the long bones of the back of your hand — are among the most common hand fractures. The classic version is the boxer's fracture: a break in the bone behind the ring or pinky knuckle, from punching a wall or another person. The end of the bone tips downward, leaving a visibly depressed knuckle.
Other metacarpal fractures — through the shaft of the bone, at its base, or behind the index or middle knuckle — need more careful assessment. Rotation matters most: even a small twist in how the bone has healed will cross your fingers when you make a fist.
Symptoms
what you may notice- Pain and swelling over the back of the hand. Immediate sharp pain after the punch or impact, with rapid swelling around the affected knuckle.
- Depressed knuckle. The knuckle behind the broken bone may look flattened or sunken compared to the others — most obvious when you make a fist.
- Difficulty gripping. Squeezing anything is painful, and grip strength drops noticeably.
- Finger crossing when making a fist. If the bone has rotated, the affected finger may overlap its neighbor — a sign that the alignment needs correction.
Diagnosis
exam first, imaging secondThree X-ray views of the hand define the fracture pattern. The most important assessment, though, is done clinically: when you make a fist, all four fingers should converge toward a single point at your wrist — any finger that crosses or gaps from the others tells your surgeon the bone has rotated and needs to be straightened. The amount of bend that's acceptable depends on which knuckle: up to about 40° at the ring or pinky knuckle (the hand tolerates that well), much less at the index or middle knuckle.
Treatment Path
how care progresses at OSI1
Buddy taping and functional splint
For minimally shifted, non-rotated boxer's fractures: tape the affected finger to the next finger ("buddy taping") inside a functional splint while the bone heals.
2
Ulnar gutter splint
A custom splint that wraps the pinky side of the hand and holds the ring and small fingers in a specific bent-knuckle position (the safest position to prevent stiffness) during early healing.
3
Closed reduction
When the fracture angle is beyond what the hand will tolerate, your surgeon numbs the finger and uses a specific technique (the Jahss maneuver) to push the bone back into alignment in the office.
Surgical Options at OSI
if non-operative care isn't enoughSurgery is needed when the bone has rotated, when it has shortened more than 4 to 5 mm, when the fracture extends into the small joint at the base of the hand (a fracture-dislocation), or when the bone won't stay aligned in a splint.
Providers Who Treat Metacarpal (Boxer's) Fracture
sports-medicine team
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: