The 17-year-old male punched a wall out of frustration and presented with pain and swelling in his right hand. On examination, he had tenderness and swelling at the base of his small finger with a bump on the back of his hand. He likely has a boxer's fracture of the small finger metacarpal. A boxer's fracture is a broken bone at the base of the small finger from punching. The patient was given a splint, instructions for reduction, pain control, and an orthopedic referral.

2.  HPI - A 17-year-old male comes to the clinic on a Friday afternoon,
complaining of pain and swelling along the outer aspect of his right
hand. He had gotten into an argument with his girlfriend and, out of
frustration, punched the wall.
 PMX- ADHD
 PSX- None
 Allegies- none
 Meds- None
 FX- HTN

3.  P- 102 BP- 134/86, RR- 18 T-98.8
 HEENT- NCAT, EMOI
 Cardio- S1, S2
 RESP- CTAB
 EXT- pain with palpation and swelling at the base of
the small finger. There is bump over the back of the
palm just below the small finger knuckle.

6.  Definition: The boxer's fracture is a broken bone of
the hand, most often at the base of the small finger,
along the metacarpal neck.
 An acceptable reduction is lateral angulation less
than 30-40 degrees
 No rotational angulation is acceptable (as seen on
AP view)
 Boxers Fractures with unacceptable degrees of
reduction will require percutaneous pin fixation to
prevent a functional deficit (pseudoclawing)

7.  Ulnar Gutter splint
 Reduction
 90-90 Reduction involves 90 degree flexion at MCP
joint, 90 degree flexion at PIP joint, pressure as shown
below:
 Pain control
 Orthopedic referral

8.  Duke orthopedics- online
 Pocket Radiologist- ER Trauma
 Emergency Orthopedics – The extremities. Robert R. Simon