A boxer's fracture is the break of the 5th metacarpal bones of the hand near the knuckle. Occasionally it is used to refer to fractures of the 4th metacarpal as well. Symptoms include pain and a depressed knuckle. Classically, it occurs after a person hits an object with a closed fist. The knuckle is then bent towards the palm of the hand. Diagnosis is generally suspected based on symptoms and confirmed with X-rays. For most fractures with less than 70 degrees of angulation, buddy taping and a tensor bandage resulted in similar outcomes to reduction with splinting. In those with more than 70 degrees of angulation or in which the broken finger is rotated, reduction and splinting may be recommended. They represent about a fifth of hand fractures. They occur more commonly in males than females. Both short and long term outcomes are generally good. The knuckle, however, typically remains somewhat deformed. Signs and symptoms The symptoms are pain and tenderness in the specific location of the hand, which corresponds to the metacarpal bone around the knuckle. When a fracture occurs, there may be a snapping or popping sensation. There will be swelling of the hand along with discoloration or bruising in the affected area. Abrasions or lacerations of the hand are also likely to occur. The respective finger may be misaligned, and movement of that finger may be limited and painful. Causes Metacarpal fractures are usually caused by the impact of a clenched fist with a hard, immovable object, such as a skull or a wall. When a punch impacts with improper form, the force occurs at an angle towards the palm, creating a dorsal bend in the bone, ultimately causing the fracture when the bone is bent too far. When a boxer punches with proper form, the knuckles of the second and third metacarpal align linearly with the articulating radius, followed linearly by the humerus. Due to the linear articulation of bones, the force is able to travel freely across these joints and bones and be dissipated without injury. Therefore, fractures of the second or third metacarpals are rare, with fractures of the 4th and 5th metacarpals comprising the vast majority of metacarpal fractures. Diagnosis Diagnosis by a doctor's examination is the most common, often confirmed by x-rays. X-ray is used to display the fracture and the angulations of the fracture. A CT scan may be done in