Fun Fact: Also known as an “Intellectually Destitute Fracture”- literally "without intelligence" fracture

          Usually, these fractures are caused by striking a solid object with a closed fist and thus are dubbed boxer fractures, although this injury almost never occurs during boxing. Typically, a skilled fighter fractures the index metacarpal because instead of using a "roundhouse" motion, the blow comes straight from the body along the line of greatest force transmission (Dye, 2006). The force from the improper roundhouse motion results in a transverse fracture of the neck of the metacarpal.

Other Differential Diagnoses Followed by How to Rule Out

• Lunate dislocation – Murphey’s Sign (Konin, 2006)

• Scaphoid fracture - Watson Test (Konin, 2006)

• TFCC – Clicking or catching with movement, mechanism typically includes a violent twist or torque of the wrist (Prentice, 2011)

• Proximal phalangeal dislocation/fracture – X-ray, spiral/angular fracture

• Dislocation of the fourth or fifth metacarpal – Gross deformity and X-ray

Special tests for boxer's fracture: Tap/Percussion, Compression, Tunning Fork (Prentice, 2011).

Signs and symptoms to look for are pain, swelling, deformity.