A Not So Routine Boxer Fracture: A Case Study and Literature Review

The authors present a case involving a boxer fracture with an atypical presentation and course. Initial evaluation and skin inspection led to the impression of a “routine” closed boxer fracture that we commonly see in our clinic. During treatment, however, it became apparent that the fracture was open and complicated by metacarpophalangeal (MCP) septic arthritis. Surgical intervention resulted in infection eradication and successful fracture union. Open boxer fractures are uncommonly seen and rarely reported. Signs of an open boxer fracture may be easily overlooked, and the consequences can be devastating. Doctors may miss a deeper injury if not making a conscious effort to consider it in every patient. It is recommended that all boxer fractures be considered a fight bite injury and thus an open fracture during initial and follow-up evaluations. This approach should be taken by any physician that manages acute clenched fist fractures to the hand.