Boxer's Fracture - ED Management

Be sure to assess for wounds in patients with fractures of the 4th and/or 5th metacarpal neck(s) and clarify if these wounds were sustained as "fight bites" as this will guide prophylactic antibiotic treatment. Here's a quick summary. 

• Most common type of metacarpal fracture 

• Fracture of the 4th or 5th metacarpal neck with volar displacement Of the metacarpal head 

• Mechanism: Closed fist blow against a person or hard surface 

• Exam: Swelling and tenderness over dorsal surface of affected metacarpal(s) 

• Possible associated injuries: lacerations (if present, need to clarify what was punched as this will guide antibiotic coverage) 

• ED Management: Pain control, reduce if needed (using hematoma block or ulnar nerve block), immobilize; if open wound, must update tetanus and give appropriate antibiotics (Augmentin if "fight bite", Keflex if hard object) as well as provide wound care (copious irrigation but no closure if "fight bite", irrigation with closure if hard object) 

• Splint: Ulnar gutter with MCP flexed 70-900 

• Ortho consult: No (unless open, severely comminuted, any malrotation, unacceptable angulation) 

• Disposition: Discharge home with orthopedic follow-up within I 



MH/CCF/CWRU EM Res @MetroHealth_EM



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