Boxer's Fracture

Boxer's Fracture - Overview

By: Jon Stiffler, PTA

Image of Boxer's Fracture

A boxer’s fracture is an injury that occurs when there is a break in a bone (fourth or fifth metacarpal) of the hand. Symptoms of  boxer's fracture include: 

  • pain at rest or during motion 
  • swelling 
  • bruising
  • decreased strength

Treatment for boxer’s fracture includes: 

  • increasing range of motion 
  • promoting muscle healing 
  • introducing specific resistive and strengthening exercises
  • integrating functional tasks to promote independence in all daily activities

This article goes over common definitions associated with boxer’s fractures, anatomy, as well as signs, symptoms, and causes. 

It also discusses the typical tests and diagnosis to determine if a boxer’s fracture has occurred, and provides an emphasis on treatment of this disorder and prevention with home remedy tips.

Anatomy Involved and Definitions

The metacarpals are condyloid joints, which are made up of metacarpal and phalangeal bones. The metacarpals are the larger bones in your hand that connect to the small bones of the hand and the fingers while the phalanges are the bones in the fingers. 

Numerous muscles and ligaments surround these bones. The fourth and fifth metacarpals are the bones involved in boxer’s fracture. The fourth metacarpal is below the ring finger while the fifth metacarpal is below the small finger.

Signs, Symptoms, and Causes

Signs and symptoms of a boxer’s fracture are: 

  • pain or difficulty moving the hand 
  • swelling
  • bruising
  • decreased strength
  • difficulty moving fingers
  • trouble grabbing objects
  • tenderness to the area

A typical cause of a boxer’s fracture is trauma to the hand near the ring and small finger. The most common cause of these fractures is from punching or hitting a hard object without proper technique.

Tests and Diagnosis

Typical tests that will be performed to diagnose a boxer’s fracture is an X-Ray to see if there is a break in the fourth or fifth metacarpal. 

The physician or therapist may also palpate or touch near the injury to determine where the break is located. A diagnosis is determined through visualization of X-Ray.


Initial treatment would consist of immobilizing the boxer’s fracture either through a cast or a customized orthosis called an ulnar gutter. If surgery is required an open reduction internal fixation or percutaneous pinning will take place. 

A therapist (occupational or physical) will focus on establishing a baseline and determining your level of function prior to the boxer's fracture injury. Therapeutic intervention include increasing range of motion (ROM) by extending the end ranges of joint mobility, introducing resistive, strengthening, and endurance exercises that focus on the specific injury and functional limitations. 

ROM is increased passively (by the therapist) or actively (by the patient). The goal is to extend the end ranges, which are typically shortened due to soft tissue swelling from the trauma of a break and immobilization without inducing pain to the boxer's fracture. 

Resistive exercises used to strengthen hand can range from flexbars, peg grasp, wrist wheels/rollers, and putty. Treatment focuses on promoting muscle healing and introducing functional activities into therapy that promote independence in the affected hand during everyday activities.

Prevention and Home Remedies

Ways to help improve your symptoms at home and to reduce pain as well as swelling include: 

  • resting the hand and affected extremity
  • icing the hand for 8-10 minutes at a time with a towel in between skin and ice pack 
  • compressing the area with an ace bandage
  • elevate the extremity above heart level by propping it on top of a pillow 
  • can take over the counter (OTC) Ibuprofen or Naproxen for pain and swelling if cleared by your physician

The Jacksonville Orthopaedic Institute will provide the highest level of care to help you return to your normal, active lifestyle. Call JOI-2000 and book an appointment today!



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