Published: 2019-04-26

Management of boxers fracture with single antegrade bent K-wire

Mohammed Sadiq, Syed Azher Hussain


Background: Fractures of the neck of fifth metacarpal are commonly encountered in orthopaedic practice. Management of these fractures is a debatable topic with treatment varying from conservative management to surgical fixation. In our study we used a pre-bent k wire in antegrade fashion to achieve fracture fixation. We found that pre-bent K wire provides an excellent reduction with good correction of neck shaft angle and good restoration of movements at the metcarpo-phalyngeal and inter-phalyngeal joints. Pre-bent K wire provides an efficient and economical modality of fixation in fracture neck of fifth metacarpal fractures.

Methods: All patients presenting with fracture neck of fifth metacarpal were managed by pre-bent K wire in antegrade fashion by a single surgeon using a single prebent K wire.

Results: All the fractures involved the dominant hand (16 right and 6 left). The mean duration of surgery was 24 mins. Intra operatively the mean no of X ray shoots were 12. At the end of the follow-up there was no significant difference in the TAM in the affected and the unaffected hand. The p=0.17. The mean DASH at the end of the follow up was 2.42. The mean fracture healing time was 45 days.

Conclusions: Boxers fracture is very common fracture type in young active adults. Conservative management is usually associated with shorting and angular deformities. Percutenous fixation of the fracture with bent K wire placed in antegrade fashion provides good stability at the fracture site.



Boxer’s fracture, Metacarpal, Neck, Pre bent K wire

Full Text:



Mohammed R, Farook MZ, Newman K. Percutaneous elastic intramedullary nailing of metacarpal fractures: surgical technique and clinical results study. J Orthop Surg Res. 2011;6:37.

Yammine K, Harvey A. Antegrade intramedullary nailing for fifth metacarpal neck fractures: a systematic review and metaanalysis. Eur J Orthop Surg Traumatol. 2014;24:273–8.

Hunter JM, Cowen NJ. Fifth metacarpal fractures in a compensation clinic population: a report on one hundred and thirty-three cases. J Bone Joint Surg Am. 1970;52:1159–65.

Gudmundsen TE, Borgen L. Fractures of the fifth metacarpal. Acta Radiol. 2009;50(3):296-300.

Ali A, Hamman J, Mass DP. The biomechanical effects of angulated boxer’s fractures. J Hand Surg Am. 1999;24:835–44.

Cepni SK, Aykut S, Bekmezci T, Kilic A. A minimally invasive fixation technique for selected patients with fifth metacarpal neck fracture. Injury. 2016;47(6):1270-5.

Diaz-Garcia R, Waljee JF. Current management of metacarpal fractures. Hand Clin. 2013;29:507-18.

Kim JK, Kim DJ. Antegrade intramedullary pinning versus retrograde intramedullary pinning for displaced fifth metacarpal neck fractures. Clin Orthop Relat Res. 2015;473(5):1747-54.

Wong TC, Ip FK, Yeung SH. Comparison between percutaneous transverse fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger. J Hand Surg Br. 2006;31:61-5.

Facca S, Ramdhian R, Pelissier A, Diaconu M, Liverneaux P. Fifth metacarpal neck fracture fixation: locking plate versus K-wire? Orthop Traumatol Surg Res. 2010;96:506-12.

Fujitani R, Omokawa S, Shigematsu K, Tanaka Y. Comparison of the intramedullary nail and low-profile plate for unstable metacarpal neck fractures. J Orthop Sci. 2012;17:450-6.

Schadel-Hopfner M, Wild M, Windolf J, Linhart W. Antegrade intramedullary splinting or percutaneous retrograde crossed pinning for displaced neck fractures of the fifth metacarpal? Arch Orthop Trauma Surg. 2007;127:435–40.

Jahss S. Fractures of the metacarpals: a new method of reduction and immobilization. J Bone Joint Surg Am. 1938;20:178–86.

Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med. 1996;29(6):602-8.

Braakman M. Is anatomical reduction of fractures of the fourth and fifth metacarpals useful? Acta Orthopaedica Belgica. 1997;63(2):106-9.

Eichenholtz SN, Yonkers NY, Rizzo PC. Fracture of the neck of the fifth metacarpal bone. Is over-treatment justified? J Am Med Association. 1961;178:425-6.

Foucher G. "Bouquet" osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg. 1995;20:86-90.

Hall RF Jr. Treatment of metacarpal and phalangeal fractures in noncompliant patients. Clin Orthop Related Res. 1987;214:31-6.

Leung YL, Beredjiklian PK, Monaghan BA, Bozentka DJ. Radiographic Assessment of Small Finger Metacarpal Neck Fractures. J Hand Surg. 2002;27:443-8.