Presentation
A patient presented to the emergency department with a swollen, red right fist after punching a wooden pole. Their 5th knuckle was tender to palpation. The patient retained full range of motion in the their wrist and fingers and remained neurovascularly intact.
Patient Data
A transverse 5th metacarpal fracture with minor radial angulation and volar angulation. Most notable in the oblique view.
Post closed reduction/traction + plaster cast
Plaster cast immobilization of the right hand and wrist. 5th metacarpal fracture alignment considered satisfactory as angulation is less than 40 degrees.
Case Discussion
This is a classic example of a Boxer's fracture, a 5th metacarpal neck fracture. This is the most common type of metacarpal fracture.
The patient was managed in the emergency department, with traction applied under nitrous oxide and a local anesthetic ring block.
The fracture was managed conservatively with closed reduction. Post-traction, a POSI (position of safe immobilization) cast was applied and X-ray scans demonstrate angulation of the 5th metacarpal shaft is under 40 degrees, which is considered adequate alignment.
The patient was discharged from the emergency department with a fracture clinic follow up booked for 1 week following the date of injury for definitive management planning.
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