A Wrong Punch and a Rare Fracture! - A Case Report of Isolated Fourth and Fifth Metacarpal Base Fracture

INTRODUCTION: Isolated displaced fourth and fifth metacarpal base fracture without a carpometacarpal joint subluxation or carpal bone fracture by a punch injury is extremely rare. The site of the fracture in the metacarpal is determined by the type and direction of punch. These fractures usually occur as a result of misdirected blow or wrong punch on a hard surface with a clenched fist. To best of our knowledge, there are only few published case reports. The difficulties in management and biomechanics of such fractures with 10 months follow-up are discussed in this case report. CASE REPORT: A 37-year-old male right hand dominant person presented with pain and swelling of the right hand after punching a wall. The difficulties in reduction and fixation of such fracture, the functional and radiological outcome of minimally open Kirschner wires fixation of this type of fracture with 10-month follow-up and the fracture biomechanics has been discussed in this case report. CONCLUSION: Clenched fist injury not always means a boxer fracture. This kind of rare fracture is also a possibility and should kept as a differential diagnosis. These fractures are easily misinterpreted by a beginner. Meticulous reduction techniques and fixation will yield better results.