Boxer's fracture recovery and exercises by stage

What is a boxer's fracture?

A boxer's fracture is a break in the neck of the fifth metacarpal, which is the long bone in your palm that runs out to the little finger knuckle. The neck is the narrow part just behind the knuckle, so the break sits at the far end of the bone, close to the joint. OrthoInfo describes the fifth metacarpal as the most commonly broken bone in the hand, and the usual cause as punching or striking a hard object with the hand closed in a fist. It also lists a fall, a car accident and other trauma as causes, and the NHS hand therapy page cited here puts falls and sport alongside hitting something with a clenched fist, so a fight is not the only way this bone breaks.

Two things get mixed up with it. The fifth metatarsal is the matching bone in the foot, and a fifth metatarsal fracture is a different injury with a different program. Boxer's knuckle is also different: that is a tear in the soft tissue hood that keeps the extensor tendon sitting centrally over the knuckle, and it can follow the same punch without any break in the bone (Fenech, 2023).

Most people notice swelling across the back of the hand within an hour, bruising that spreads over the following days, and a knuckle that looks lower or flatter than the one next to it. OrthoInfo describes exactly that: the knuckle may look sunken in or depressed, which comes from the end of the bone tipping down into the palm.

Why is a bent knuckle often accepted?

Because this particular bone tolerates being bent far better than it looks as though it should. The fifth metacarpal sits on a mobile joint at the wrist end, so the hand can compensate for a fair amount of tipping without losing grip.

The numbers in use have moved over the years, which is why two clinicians can quote you different figures and both be reading the literature correctly. Older teaching accepted around 30 degrees. Current practice commonly works to a reference of about 60 degrees, and one randomized trial treated fractures angulated up to 70 degrees with a pressure bandage and immediate movement, with no difference from three weeks in a cast in range of motion, pain, satisfaction or return to work (Lixa and colleagues, 2024; Statius Muller and colleagues, 2003).

The study that makes this easiest to accept looked at function, not at angles. In 218 little finger metacarpal fractures treated without any attempt at straightening the bone, how severe the palmar angulation was did not affect little finger grip strength or the DASH score, and the 18 neck fractures that were operated on did no better than the 105 that were not (Westbrook and colleagues, 2008). So being told to accept a bent knuckle, in a fracture that fits those criteria, is a plan with evidence behind it rather than neglect.

What the bend does cost you is the appearance of the knuckle, and that part is usually permanent. People treated in a cast in one comparison were more satisfied with how the hand looked than people who had wires, where the scar became the complaint (Lixa and colleagues, 2024).

What is the difference between angulation and rotation?

Angulation is the bone tipping, and you see it as a sunken knuckle. Rotation is the bone twisting along its own length, and you see it in the fingers, not in the knuckle. They are not two grades of the same problem, and rotation is the finding that changes what happens next.

Close your hand slowly and look down at it. The fingers should fold in beside each other and the fingernails should sit in a smooth, even line. If the little finger crosses over or tucks under its neighbor, or points off to the side, that is the picture OrthoInfo describes as the injured finger crossing over its neighbor when making a fist. A hand can look almost normal when open and only show it on closing, which is why the open hand is not the test.

Rotation is treated as a formal reason to operate, along with an open fracture and pseudoclawing, where the knuckle is bent so far that the finger cannot straighten out level with the others (Lixa and colleagues, 2024). The trial that supported early movement up to 70 degrees applied it only to fractures that were not rotated (Statius Muller and colleagues, 2003). Rotation is also easier to correct early than late, so it belongs in front of your clinic the day you notice it, not at a routine review.

How a boxer's fracture is usually treated

Treatment starts with an X-ray and an examination of how the fingers line up, and then most of these fractures are held still in something simple. Buddy strapping, where the little finger is taped to the ring finger, is widely used for head, neck and shaft fractures, sometimes with a soft splint worn for about three weeks (North Tees and Hartlepool NHS Foundation Trust). An ulnar gutter cast, which holds the little and ring fingers along the outer edge of the hand, is the other common choice, and in one recent comparison the non-operative group had closed reduction followed by three weeks in it (Lixa and colleagues, 2024).

OrthoInfo puts immobilization for a hand fracture at 3 to 6 weeks depending on the location and the stability of the break, with a follow-up X-ray usually at about 1 to 2 weeks to confirm the alignment is holding. Which end of that range you are at, and whether your knuckles are covered at all, is a decision for the unit treating you.

Nobody has shown that one non-surgical method beats the rest. A Cochrane review of five trials in 252 adults found no single conservative method superior to another, and said plainly that the trials were of limited quality and size and that not one of them had measured hand function with a validated score (Poolman and colleagues, 2005). A later pooled analysis of seven randomized trials and 454 patients found buddy taping gave better pain scores at 12 weeks than reduction and casting, with no difference in satisfaction (Mohamed and colleagues, 2022). Both were working with small trials, so the honest reading is that several approaches work, not that one is correct.

Surgery, when it is used, is usually wires passed down inside the bone or a plate on its surface. In the comparison above, surgery left the bone straighter at discharge by about 10 degrees, which the authors described as a statistical difference that was not a clinical one, and the hand function scores at a year were much the same in both groups (Lixa and colleagues, 2024). Their conclusion was that surgery should be kept for complex fractures. None of the 60 fractures in that study, operated or not, had failed to join by the one year review, which fits what hand surgeons expect of this bone: it is the shape it heals in that gets discussed, not whether it heals.

Why a cut over the knuckle changes everything

A fracture caused by striking a person's mouth is a separate problem, and the wound matters more than the break. The skin over a closed fist lies almost directly on the extensor tendon and the knuckle joint capsule, so a tooth that breaks the skin can carry mouth bacteria into the joint and the tendon. A review of bite injuries to the hand describes these clenched fist injuries as the worst bite infections there are, and explains why: they are small, they look minor, and they are treated as minor (Malahias and colleagues, 2014).

The same review makes two points worth carrying into an emergency department with you. A fragment of tooth can be left behind in the wound, and a break in the metacarpal head can be missed on a plain X-ray. Washing the wound out properly is the treatment, in an operating room where that is needed, with antibiotics alongside rather than instead.

NHS advice is to call 111 for any bite from a person and any bite to the hand, and to go to an emergency department for a wound that is large or deep. On this page the advice goes further than that, deliberately: go to an emergency department the same day for any break in the skin over a knuckle after your hand hit someone's teeth, even a small one, even one that has already closed, and say what caused it rather than describing it as a cut.

The prescribing guideline behind that advice points the same way. NICE offers preventive antibiotics for a human bite that has broken the skin and drawn blood, treats the hand as a high-risk area where antibiotics are worth considering even if no blood was drawn, and refers a bite to hospital when the wound has gone into a joint, a tendon, a nerve or bone (NICE guideline NG184). Nobody can tell from outside the skin whether a tooth reached the knuckle joint, which is why the whole group goes in rather than the ones that look deep. Expect your tetanus cover to be checked at the same visit.

What does recovery from a boxer's fracture look like?

Swelling and bruising dominate the first week or two, and then the picture changes from a sore hand to a stiff one. The pain usually settles well before the function does, which catches people out.

Stiffness is the real long-term problem here, not pain and not the knuckle's shape. OrthoInfo is direct about the cause: a hand kept still for a long period can stiffen, and therapy exercises help limit it. The joints that lose the most are the big knuckles where the fingers meet the hand, which is why the tabletop finger bend is in stage 1 on its own instead of being folded into making a fist.

Grip is the slowest thing to come back, because grip needs the hand to hold force, not just to move. A rough sequence most people follow: full finger movement first, then the hand feeling like your own again, then grip, then confidence in using the hand hard. One NHS hand therapy service puts light tasks in the first three weeks, heavy tasks and non-contact sport at six weeks, and contact sport, boxing in particular, at 12 weeks (North Tees and Hartlepool NHS Foundation Trust).

Some ache across the back of the hand during harder tasks is common for a couple of months. Pain that climbs week by week instead of settling is not, and belongs in the warning signs rather than in a lighter session.

How to use this program

Stage 1 is for the weeks in strapping, a splint or a cast. After that, let your fracture clinic's advice decide when each stage starts, because it depends on how the break is held and what the X-rays show. Move up when the current stage feels easy and the hand is no worse the next morning, and stay where you are if you are not sure. These stages are written for adults. If the person with the fracture is still growing, follow the plan the fracture clinic gives instead of the stages here.

Each exercise page gives its own starting dose. Across this program that is mostly 5 to 10 slow rounds of the finger and wrist movements several times a day, then 2 to 3 sets of 10 to 15 for the grip work later on. Where a stage on this page gives a number and the exercise page gives a different one, use the stage, because the stage numbers are set for a healing metacarpal and the exercise pages are written for hands in general. Your physio or physical therapist will adjust the exercises and the numbers to your break and your job.

In stage 1 the movements should not hurt at the break. From stage 2 on, a stretch or mild discomfort is fine if it settles soon after you stop and the hand is no worse the next morning. Sharp pain at the knuckle, or pain that builds with each repetition, means stop.

Swelling needs one specific caution on this page. Keeping a swollen hand up helps, and the height is to about the level of your heart and no higher. Not higher than your heart and no ice, because if pressure is building up inside the forearm both of those cut down the blood reaching the hand (Willy and colleagues, 2016). The full line, including the point at which 30 minutes is long enough to wait, is in the warning signs at the end of this page.

Read those warning signs before you start stage 1 rather than after something happens. Three of them belong in your head from day one: fingers that turn blue, white or pale or feel cold, a hand that goes tight and hard across the palm or the back of the hand while the pain keeps climbing, and any cut over a knuckle from striking teeth. All three send you to an emergency department rather than to a clinic appointment.

The exercise program

The exercises below carry their own stop signs and precautions. Open the line under an exercise and read them before you try it.

What we notice in the clinic

The commonest mistake is the sensible one. The hand is strapped, so people protect it completely, and three weeks later the knuckles have stiffened into exactly the position the strapping held them in. Moving the fingers early is not bravado and it does not disturb the break when it is done as your clinic set out.

The second is never getting the hand checked at all, because the fingers still work. The fracture that needed something more than strapping is identified on an X-ray and by looking at how the fingers line up, and a hand that closes into a fist is not evidence that both of those are fine. If you did not go anywhere at the time and the knuckle is still sore and stiff a few weeks later, go now instead of waiting longer.

Then there is the fist check, which almost nobody is shown. Close the hand slowly in front of a mirror and compare it with the other one. Crossing or scissoring fingers is the single finding most worth reporting, and you can see it yourself in ten seconds.

Last, the thing people do not say out loud. Punching a person or a wall is a common cause of this break, and embarrassment is part of why the hand is not shown to anybody for a week. Nobody treating a hand is interested in how it happened beyond one detail, which is whether the hand hit teeth.

If your fracture was fixed with wires or a plate

Then this is not your program. What was done inside your hand, how stable the fixation is and how long the bone needs all change when you may move and grip, and only your surgical team knows those things. Their plan replaces every stage and every date here.

A wire or a plate holds the pieces in place while the bone heals. It is not proof that the bone has healed, so gripping hard, lifting and anything that reloads the knuckle waits for your team's say-so rather than for the pain to go. Where wires are left poking through the skin, how to keep that site clean is part of their instructions too, and taking them out is their job, not yours.

Three things apply whatever else they tell you: do not pull a wire, trim it or try to take one out; keep the hand out of baths, pools and washing-up water while the wires are in, unless your team has said otherwise; and ring them the same day if a wire works loose or starts to stick out further than it did. In the comparison cited earlier on this page every wire was removed between 6 and 12 weeks after the operation, with the timing set by how much new bone had formed on the X-ray (Lixa and colleagues, 2024). A wire that comes out through the skin also leaves a track running down to the bone, which is why a pin site that is getting redder or more painful, or starting to discharge, has a warning sign of its own below.

Three of the warning signs on this page are written for an operated hand: one for a wound or a fever, one for a pin site where a wire comes through the skin, and one for new severe pain, a grip that gives way, a finger that stops straightening or a sense that something inside the hand has shifted. All three ask you to contact your surgical team the same day instead of waiting for a routine appointment.

When to see a physio or doctor

See your fracture clinic, physio or doctor if the hand is not getting steadily easier once the strapping is off, if you cannot make a full fist by about six weeks, if your grip is not improving over several weeks, or if the little finger does not straighten out level with the others. Ask for a hand therapy referral if your work or sport needs real force from that hand.

Get it checked the same day if the fingers no longer line up when you close your hand, and go to an emergency department for any wound over a knuckle from striking teeth. The warning signs on this page give the route and the timing for each. The broken wrist program and the scaphoid fracture program cover the two common wrist breaks, which are different injuries with different timelines. Tendon glides and opening and closing the hand are the two movements most hand programs start with. The hand grip squeeze and ball grip and release are where the grip work begins.

For physiotherapists

This page covers adult fifth metacarpal neck fractures managed non-operatively, with a hand-over section for fixed fractures. Staging is written against the immobilization, not the calendar: stage 1 for the period in buddy strapping, splint or cast, stage 2 on removal and clinic review, stage 3 on the clinic or physio agreeing the bone will take load, stage 4 on agreed union. The week markers quoted in the stages, three weeks of light tasks, six weeks for heavy tasks and non-contact sport, 12 weeks for contact sport and boxing, come from the North Tees and Hartlepool hand therapy page and are given as that service's figures rather than as a universal protocol. NICE NG38 sets no timeline for a metacarpal fracture, so there is no guideline-level alternative to attribute. What it does ask is that the treating team gives the patient the expected time to return to usual activities in writing, which is why the stages gate on clinic clearance and quote the weeks as orientation only.

Two of the cited sources give different starting points for movement, which is why stage 1 is split by what is holding the hand. OrthoInfo puts gentle hand exercises at usually after three weeks, in a treatment section that covers casts, removable splints and buddy straps together; the North Tees hand therapy page tells patients to start exercising the fingers straight away and to work through the exercises 4 to 5 times a day. Read as populations rather than as a conflict, the two describe different hands, and each says the same thing about its own: OrthoInfo calls the taped neighbor a moving splint, and North Tees notes that its hand casts still allow finger movement. So stage 1 prescribes finger movement from the first days where the knuckles are free, holds the knuckles and moves every uncovered joint where a splint or cast covers them, tells the reader not to remove a splint or cast to exercise, and leaves the final word with the treating clinic. Its frequency and repetition figures are the North Tees ones.

Angulation figures are attributed, not endorsed: the approximately 60 degree working reference and the older 30 degree figure are reported as Lixa and colleagues report them, the 70 degree figure is the inclusion ceiling of Statius Muller and colleagues 2003 (n = 40 randomized, 35 completed, mean angulation 39 degrees, range 15 to 70), and the functional claim rests on Westbrook and colleagues 2008 (218 non-operatively treated little finger metacarpal fractures, 105 neck and 113 shaft, against 44 operative; palmar angulation severity did not affect little finger grip strength or DASH). No page sentence tells a reader what angle is acceptable in their own fracture.

Rotation is handled as a management-changing finding, not a severity grade, with the fist and nail-line check given to the patient, and it carries its own same-day warning line. Pseudoclawing is named in plain words as an operative indication alongside open fracture and rotation (Lixa and colleagues, 2024, introduction and discussion). The Lixa cohort excluded rotational deformity, so its equivalence findings apply only to non-rotated fractures, and the page does not generalize them.

The fight bite line is the one warning on this page that is stricter than the patient-facing source behind it. NHS advice for a human bite or a bite to the hand is to call 111, with an emergency department for a large or deep wound. The line sends every break in the skin over a knuckle after striking teeth to an emergency department the same day, on the grounds set out in Malahias and colleagues 2014: the dorsal MCP skin sits on the extensor hood and joint capsule, capsular breach can produce purulent arthritis, retained tooth fragments and occult metacarpal head fractures are described, and antibiotics are an adjunct to washout rather than a substitute. The review's figure for the proportion of bite injuries that become infected is not quoted on the page, because it reaches that review through a citation chain that has not been traced to the paper behind the number. NICE NG184 supports the direction without settling the tier: it offers prophylaxis for a human bite that has broken the skin and drawn blood, names the hand as a high-risk area, and refers to hospital any bite that has penetrated a joint, tendon, nerve or bone, which is a judgment no patient can make from the outside.

The cast warning lines need a strapping twin on this page. The house cast lines both open with "in a cast or splint", and the commonest immobilization for this fracture is buddy strapping or tape, so a reader whose tape is strangling a finger would match nothing. The page carries a strapping line at the same tier as the cast line, with removal of the tape as the first action, on the pattern of the BOA compartment syndrome standard, which asks for circumferential dressings to be released to the skin, the limb elevated and the patient re-evaluated within 30 minutes.

Removal rather than loosening is deliberate. Our mallet finger program tells a reader to loosen the tape and take a tight finger splint off, and that splint is holding a tendon in a position it must not leave, which is more to lose than a stable metacarpal neck fracture has. Statius Muller and colleagues treated these fractures with a pressure bandage for one week and immediate movement with no loss against three weeks in a cast, so the bone tolerates a short period out of tape. The reader is still told not to take a plaster cast off.

A pale, blue or cold finger has an emergency line of its own, separate from both the cast line and the strapping line. The house cast line opens "while you are in a cast or splint", and the strapping line sits in a tier that allows 30 minutes, so without that separate line one symptom would carry two urgencies on one page depending on what was holding the hand. The stricter reading is the sourced one: our mallet finger page puts a fingertip that turns blue, white or pale or feels cold at the emergency tier "in the splint or out of it", and the 30 minute re-evaluation in BOA standard 7 is a clinician reassessing a patient, not a patient waiting at home. Numbness, tingling, tightness and swelling stay in the lower tier, which keeps the strapping pair matched to the cast pair.

The falls lines belong on this page as well, although the mechanism here is usually a punch: the falls assessment line, the unexplained-fall emergency line and the blackout line. OrthoInfo names a fall among the causes of a boxer's fracture and the North Tees page puts falls first among the causes of metacarpal fractures, so the older reader who broke this bone in a fall is a real reader of this page, and the four sibling upper limb fracture pages carry the same lines. NICE NG38 asks for falls risk to be assessed from first presentation in anyone with a fracture (recommendation 1.5.1), which is the guideline-level warrant for them.

Compartment syndrome needs the hand named alongside the forearm. In the first-weeks emergency line the explanation reads forearm or hand, because the hand has its own closed compartments and, in a systematic review of the causes of traumatic hand compartment syndrome covering 129 patients, 7 of them had a fracture and a broken metacarpal was the commonest of those (Alsaedi and colleagues, 2023). The house cast and color line stands exactly as it is, on purpose: its trigger is a color change, it names two mechanisms behind one immediate action, and a reader with a discolored finger inside a cast is routed by what she can see, not by the explanation. The hand clause matters because the usual stretch test does not test the hand: passively straightening the fingers loads the long flexors, whose muscles sit in the forearm, while the intrinsic compartments are stretched by extending the knuckle with the middle joint bent. So rather than ask a reader with a fresh fracture to perform a test on herself, the trigger names a hand that goes tight and hard as something she notices.

Pin site care has a same-day line of its own instead of a widened wound line, because the commonest operation for this fracture leaves wires through the skin and a reader with wires and no incision matches nothing in a line about a wound: percutaneous antegrade intramedullary wires, removed at 6 to 12 weeks depending on callus, is the operative arm of the study this page cites (Lixa and colleagues, 2024), and pin site infection needing antibiotics, early wire removal or a further operation occurred in 85 of 1,213 hands and wrists fixed with percutaneous wires, most of them mild (van Leeuwen and colleagues, 2016). The failing-fixation line includes a sudden loss of active extension at the knuckle, because the extensor tendon lies directly on the back of the metacarpal and can catch or give way over a plate or a wire, which is assessed separately from the bone.

Three decisions are worth stating plainly so they are not reopened. Rotation keeps the same-day tier: it is a formal operative indication and easier to correct before callus forms, but it puts no nerve, vessel or skin at risk, and an out of hours emergency department cannot correct it, so a fracture clinic the same day is both the faster route and the right one. The reader takes buddy tape off herself: the tape is the circumferential layer with nothing else to release, and a metacarpal neck fracture is stable enough to tolerate a short period out of it, while the instruction not to remove a plaster cast holds. And no figure is given for the share of these fractures that are operated on, or for a non-union or malunion rate, because the readable hand fracture epidemiology pools carpal, metacarpal and phalangeal fractures into one operative proportion, which is the wrong denominator for this one fracture. The absence of non-union in the 60 fractures followed for a year by Lixa and colleagues is reported on the page as that study's own result, which is all it can carry: its surgical group's mean angulation of 53 degrees was lower than the commonly quoted 60 degree reference, which those authors attribute to their own department's threshold, so their 30 operated of 60 is a selection and not an incidence.

The dose caps sit on this page and not on the library exercise pages, which are written for hands in general. The library page for the hand grip squeeze instructs a squeeze as firmly as you comfortably can, so stage 3 caps the effort at about half and defines start light; the hand gripper exercise and towel wringing pages name the base of the thumb in their stop signs, so stage 4 redirects the reader's attention to the little finger knuckle and the ulnar border; ball grip and release is placed in stage 2 rather than stage 1 because its own entry gate asks for clearance that a stage 1 reader will not yet have, while its pumping variant is the swelling tool this fracture needs. Stage 4 also carries the breathing instruction, because the hand gripper exercise is the hardest squeeze in the program and its own page names breath holding only as a common mistake, while the two softer grip pages used in stage 3 state it as a precaution. The stages are stated as adult, with anyone still growing sent back to their own fracture clinic.

Stage 1's split needs a test the reader can perform, so she is told to look at the hand and try the knuckles gently, with the clinic's word overriding what she sees and a ring-and-ask route where she cannot tell. She is also told outright that none of the three listed exercises is for her yet if the knuckles are covered, because all three flex them and a reader who sees three tiles under the stage will otherwise do them. Stage 1 gives the North Tees repetition figure (10 of each movement) alongside its frequency, and the How to use section says the stage number replaces the exercise page number where the two differ. That rule is a cap rather than a license: the library pages put the wrist and tabletop work at 2 to 3 sets of 10 to 15, 1 to 4 times a day, which at the top of both ranges and 4 to 5 sessions is several times the source protocol's volume on a hand three weeks out of a fracture, and stage 2's own 5 to 10 repetitions is lower again than the pages it links to.

Stage 3 defines half effort by how the squeeze feels rather than as a fraction of an untested maximum, because half as hard as you could manage asks the reader to find her maximum in order to halve it, and that is a maximal grip test on a recently healed metacarpal. Stage 3 also sets its own session count instead of leaving it to the three library pages: at the top of their own ranges the grip squeeze, putty curl and finger spread come to roughly 225 resisted repetitions a day (45, 90 and 90, counted from their dosage lines), so the stage takes the lowest figure each page gives, which is one session a day for the three together. Stage 2 names the heart-level cap as an override of the ball page's upright forearm set-up, and stage 4 offers a thumb-side or towel-supported forearm position, because the gripper page rests the forearm little finger side down on the fractured border, which is the same objection that keeps passive finger flexion out of the program.

Passive finger flexion is left out of the program on purpose, although the stiff metacarpophalangeal joint is what it is for. Its set-up rests the hand on its little finger side on a table, which is the fractured border of this hand, and passive stretching of a recently healed metacarpophalangeal joint belongs with a hand therapist rather than in an unsupervised program. The page routes persistent stiffness to a hand therapy referral instead, including a within-a-few-days warning line for a fist that is not full by about six weeks.

Common questions

References

1. American Academy of Orthopaedic Surgeons. Hand fractures. OrthoInfo. https://www.orthoinfo.org/en/diseases--conditions/hand-fractures/
2. North Tees and Hartlepool NHS Foundation Trust. Hand therapy: metacarpal fractures. https://www.nth.nhs.uk/resources/hand-therapy-metacarpal-fractures/
3. Statius Muller MG, Poolman RW, van Hoogstraten MJ, Steller EP. Immediate mobilization gives good results in boxer's fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Archives of Orthopaedic and Trauma Surgery. 2003;123(10):534-537. https://doi.org/10.1007/s00402-003-0580-2
4. Westbrook AP, Davis TRC, Armstrong D, Burke FD. The clinical significance of malunion of fractures of the neck and shaft of the little finger metacarpal. Journal of Hand Surgery (European Volume). 2008;33(6):732-739. https://doi.org/10.1177/1753193408092497
5. Poolman RW, Goslings JC, Lee J, Statius Muller M, Steller EP, Struijs PAA. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database of Systematic Reviews. 2005;(3):CD003210. https://doi.org/10.1002/14651858.CD003210.pub3
6. Mohamed MB, Paulsingh CN, Ahmed TH, et al. A systematic review and meta-analysis of the efficacy of buddy taping versus reduction and casting for non-operative management of closed fifth metacarpal neck fractures. Cureus. 2022;14(8):e28437. https://doi.org/10.7759/cureus.28437
7. Lixa J, Vital L, Vieira P, Esteves A, Silva M, Pinho A, Vidinha V. A comparative retrospective study on surgical versus conservative treatment of simple fifth metacarpal neck fractures. Cureus. 2024;16(11):e73439. https://doi.org/10.7759/cureus.73439
8. van Leeuwen WF, van Hoorn BT, Chen N, Ring D. Kirschner wire pin site infection in hand and wrist fractures: incidence rate and risk factors. Journal of Hand Surgery (European Volume). 2016;41(9):990-994. https://doi.org/10.1177/1753193416661280
9. Malahias M, Jordan D, Hughes O, Khan WS, Hindocha S. Bite injuries to the hand: microbiology, virology and management. The Open Orthopaedics Journal. 2014;8:157-161. https://doi.org/10.2174/1874325001408010157
10. Fenech M. Boxer's knuckle: sonographic anatomy and assessment of sagittal band tears of the dorsal hood. Australasian Journal of Ultrasound in Medicine. 2023;26(4):216-229. https://doi.org/10.1002/ajum.12363
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13. National Institute for Health and Care Excellence. Fractures (non-complex): assessment and management. NICE guideline NG38. Published 17 February 2016. https://www.nice.org.uk/guidance/ng38
14. British Orthopaedic Association. BOA Standard: Diagnosis and management of compartment syndrome of the extremities. Revised July 2025. Read 29 October 2026. https://www.boa.ac.uk/asset/D0432D40%2D5D99%2D4B64%2D9952F6EB1B60C166/
15. Alsaedi O, Alshahir AA, Alsuhaibani O, Beek A, Alduheim M, Alzahim A, Alzolaibani SM, Alhusaini B. Etiology of trauma-related acute compartment syndrome of the hand: a systematic review. Cureus. 2023;15(4):e38218. https://doi.org/10.7759/cureus.38218
16. NHS. Complex regional pain syndrome. Page last reviewed 27 October 2022. https://www.nhs.uk/conditions/complex-regional-pain-syndrome/
17. NHS. Sepsis. Page last reviewed 14 May 2026. https://www.nhs.uk/conditions/sepsis/
18. North Bristol NHS Trust. Care of plaster casts. October 2024. https://www.nbt.nhs.uk/care-of-plaster-casts
19. Willy C, Stichling M, Engelhardt M, Vogt D, Back DA. [Acute therapeutic measures for limb salvage Part 1: Haemorrhage control, emergency revascularization, compartment syndrome]. Unfallchirurg. 2016;119(5):374-387. https://doi.org/10.1007/s00113-016-0179-z

Written and checked by the PocketPhysio editorial team. Last updated 2026-10-29.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.