The most common cause of a boxer’s fracture is the force applied to the fifth metacarpal bone when the fist punches something while in a clenched position. Less commonly, this fracture may also occur from getting the hand crushed.
Signs and Symptomsh
Boutonnière deformity is generally caused by a forceful blow to the top (dorsal) side of a bent (flexed) middle joint of a finger. It also can be caused by a cut on the top of the finger, which can sever the central slip (tendon) from its attachment to the bone. The tear looks like a buttonhole (“boutonnière” in French). In some cases, the bone actually can pop through the opening. Boutonnière deformities may also be caused by arthritis.
To determine if you have a fracture, your doctor will likely take an x-ray. Treatment varies depending on how far out of place the bone is located. If it is out of place too far, the doctor or provider may offer to push it back into place and cast it or may offer surgery.
Typically, it will be about 3-6 weeks in a cast or similar device (Figure 3). After the cast is taken off, you’ll be encouraged to get the fingers moving.
This is frequently done with pins through the skin, but there may be other options depending on the specific fracture. Sometimes, the surgeon will recommend therapy afterwards to help with motion.