Boxer's fracture classically involves fracture at the neck of which metacarpals?

• A. Second and third metacarpals.
• B. Fourth and fifth metacarpals.
• C. First and second metacarpals.
• D. Third and fourth metacarpals.

Answer: (B)

Punching with a clenched fist concentrates force at the knuckles and most often traumatically affects the metacarpals that form the little and ring fingers. The necks of these two metacarpals are the thinnest and are least protected by the surrounding joints in a direct axial load, so they are the ones most likely to fracture when a hard object is struck. In this injury pattern, the distal fragment typically angulates palmarly due to the pull of the surrounding soft tissues and tendons, producing the classic deformity seen with a boxer's fracture. Because the little and ring finger metacarpals bear the brunt of the impact, this fracture pattern is described as involving the necks of those two metacarpals.