Figure boxer4

Figure Legend: Complications of boxers fractures.  Penetrating injuries of the metacarpal head from clenched fist bite injury mechanism are frequently delayed in presentation, and may rapidly progress to pyarthrosis and osteomyelitis.  The patient may present with infection and a trivial appearing wound (1), masking a direct injury of the metacarpal head (2). Casual inspection of the wound in the emergency room may be misleading because the offset of soft tissue and joint penetration at the time of injury (3) is different than at the time of presentation when swelling results in metacarpophalangeal joint extension (4).  Palmar angulation of the distal fracture fragment (5) may result in tendon in balance and secondary flexion contracture of the proximal interphalangeal joint, usually to the same extent as angulation of the fracture malunion (6).
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