In a boxer fracture, what angulation threshold requires referral for reduction?

• A. Less than 10 degrees
• B. 10-19 degrees
• C. 20-29 degrees
• D. Greater than 40 degrees

Answer: (D)

In a boxer fracture, the amount of bend at the fifth metacarpal neck guides whether to treat with splinting alone or to reduce the fracture. Small angulation can be managed with immobilization and will often remodel or heal well without needing a procedure. When the angulation is high—roughly greater than 40 degrees—the deformity is unlikely to align properly with a simple splint, increasing the risk of malunion, altered finger alignment, and functional loss. In that situation, referral for closed reduction is recommended to realign the bone under appropriate analgesia and then immobilize again to ensure proper healing. Rotation deformity or comminution would push toward reduction regardless of the angle, but the key threshold here is the >40-degree angulation that prompts referral for reduction.