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Brawler's fracture

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Fractures of the metacarpal neck invariably result from punching with the fist. The fifth metacarpal is most commonly affected with occasionally, involvement of one of the other metacarpal bones.

There is often local swelling and flattening of the knuckle. X-ray usually reveals a transverse fracture with forward tilting of the distal fragment.

Angular deformity up to 20 degrees can be accepted but any rotation deformity must be corrected. The finger is held in flexion in plaster extending from below the elbow to the proximal finger joint for about 10 days.

Percutaneous Kirschner wiring is indicated if the fracture tends to redisplace.

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