Presentation
Medial metacarpal pain following a fist fight. On physical exam, the fifth metacarpal shaft had a prominent dorsal bone deformity with hyperextension of the fifth MCP joint.
Patient Data
Non-displaced fracture over the distal one-third shaft of the fifth metacarpal bone. Several fracture lines are visible on posteroanterior and oblique views. Volar angulation of the distal fifth metacarpal bone is evident on oblique view.
Case Discussion
Metacarpal fractures make up 40% of all hand fractures. Most occur in younger males secondary to a punching mechanism or direct blow over the dorsum of the hand. Spiral and oblique fractures are often seen with histories of punching while transverse fractures are typically seen after trauma to the dorsum of the hand. The eponym “boxer fracture” is specifically used when a fifth metacarpal neck fracture occurs secondary to a punch. In metacarpal fractures, the palmar angulation of the distal bone creates a dorsal bone deformity with hyperextension of the MCP joint on physical examination.
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