Boxer's Fracture?? How long before seeking medical attention

[grndslm]

I got in a fight last night. One hitter quitter. The knuckle of my middle finger is pretty swollen right now. It wasn't that bad last night. Two hours after the fight, I was playing pool with minimal pain. Since I have no insurance, I'm wondering how long I can wait before having the more serious consequences of a fractured hand... my friend's mom says hours... but I'd guess a couple days?? Hopefully the swelling will decrease, and I'll be able to close my fist in those couple days of icing & elevation.

There's also a bump on the back of my hand... right above my wrist, and what seems to be my middle finger (and maybe index too, but I can still move that one). I've read that this bump prolly wont go away. Is this a clear sign of a fracture? Is there any clear sign??

I've also read that boxer's fractures are usually associated with ring and/or pinky fingers. What's up with that?

[Tom Plamondon PA-C]

Hello,
Pain and swelling in the hand are signs of either fracture of sprain. Judging by the mechanism, fracture should be ruled out with an xray.

A fracture to 5th metacarpal bone (boxer's fracture) occur as a result an angulated force to the hand (eg a right cross) rather than a direct blow down straight through the hand (eg a jab). Martial arts users are taught to strike a straight forward blow thus avoiding hand fracture. If you watch a fella break a board with his fist, you will notice the force is directly parallel or axial to the forearm bones and the wrist is locked in neutral - there is no roundhouse punch to break the board as this would break the hand.

Take care. Let us know how it turns out.

[grndslm]

Hah... thanks for the martial arts tips. I had to go with the right cross because I had to put everything I had into it. Guy was a bit bigger than me and had just gotten outta jail, so I knew I only had 1 shot or I woulda been pulp for not putting him down.

I really don't have money to be spending on x-rays, but I had to go since I definitely need use of my hand/finger. I guess I'm lucky that it wasn't fractured, but even if it was... there's not much a doctor could do besides put it in a splint/cast, right? I mean, it's not completely broken... so there's nothing that needs to be reset.

My own personal recommendation to any others who think they have a boxer's fracture on their middle knuckle from punching someone in the face and not a wall... if you can move the finger thru approx 1/3 its normal motion, then just put the thing in a splint and don't move it, keep it elevated, and alternate icing every 20 min.

Due to my lack of insurance and the possibility of others not having it... what's the max time you docs would hold out on visiting for x-rays?? I got paranoid when people were telling me I only had "hours to properly set a fracture"... but am I wrong in thinking you could make it 3 or 4 days. I'd think it should be obvious by that point if it's just a sprain or not. Opinions? Facts?

Thanks again.

[grndslm]

P.S. - It was a straight cross... no hook. Doesn't get any straighter or harder than the fastball I threw him.

[Tom Plamondon PA-C]

Hello,
Fracture care depends on the bone fractured and the extent of fracture. If there is minimum displacement or angulation in the fracture then no fixation or reduction is needed. You can get healing with splinting, ice, and pain meds. However some fracutures shatter bone or show significant angulation or displacement then reduction (bringing the pieces together and in good alignment) is needed.
I say all this to say, it is important to xray bones which may be fractured.
Take care and keep us posted.