The boxer’s fracture is a fracture of the 5th metatarsal (little finger side). As this is obviously not the target area of contact with a punch, this injury is often caused by suboptimal punching technique. In a typical punch, the knuckles of the 2nd and 3rd rays should make contact, allowing for a smooth transfer of force across the joint. However, when contact is made with the 4th or 5th rays, it causes a bending force through the bone. 

Boxer’s fractures occur acutely, and the athlete will experience localised pain to the area, which will frequently be accompanied by swelling and some visual deformation. With closing of the fist, the little finger may cross over the other fingers. Movement of the little finger in particular will be painful. 

For stable fractures with less than 70 degrees of angulation, the injury can often be managed conservatively with splinting for 4 to 6 weeks with the metacarpophalangeal joint (knuckle) flexed to 70 degrees. 

Fractures involving shortening or rotation of the bone, as well as intra-articular fractures (fractures occurring within the joint space) will likely do better with surgical management. Long-term outcomes with metacarpal fractures have been shown to be better with intramedullary pinning (inserting a pin lengthwise through the bone) as opposed to transverse (sideways) pinning (1). Another important aspect of the surgical process is that the bone length is restored as much as possible, as a shortening in bone length is likely to negatively impact punching mechanics. Even following surgical repair, a visible deformity of the bone is likely to remain.

  1. Winter M, Balaguer T, Bessiere C, Carles M, Lebreton E. Surgical treatment of the boxer’s fracture: transverse pinning versus intramedullary pinning. J Hand Surg Eur Vol. 2007;32(6):709–713.

About the author

Sam Gilbert

Sam Gilbert is a registered physiotherapist with the Australian Physiotherapy Association (APA) and certified strength and conditioning specialist (CSCS) with the National Strength and Conditioning Association (NSCA). He holds a bachelor’s degree in Physiotherapy from Latrobe university (Melbourne, Australia) and a master’s degree in Exercise Science (Strength and Conditioning) from Edith Cowan University (Perth, Australia).

A 3rd Dan black belt in Shinkyokushinkai Karate under the World Karate Organisation (WKO), Sam participated for over 20 years in full contact competition, winning multiple state and national titles, and culminating in a 4th place in the heavyweight division of the Shinkyokushinkai World Cup in 2009.

As the co-founder and clinical director of Club 360, the premier multi-disciplinary health and fitness center in Tokyo, Japan, Sam has combined his practical experience with an in-depth study of sports performance in relation to combat sports, and strives to help other combat athletes reach their full competitive potential, whilst at the same time decreasing injury risk and increasing competition and training potential.

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By Sam Gilbert