Which fracture is a fifth metacarpal transverse neck fracture from a straight punch?

• A. Colles fracture
• B. Smith fracture
• C. Bennett fracture
• D. Boxer's fracture

Answer: (D)

The main concept being tested is recognizing a Boxer's fracture, which is a transverse fracture through the neck of the fifth metacarpal caused by punching a solid object with a clenched fist. When a direct blow is delivered with a closed fist, the force concentrates at the neck of the fifth metacarpal, often producing a clean transverse break with the distal fragment angulated palmarly. This pattern creates tenderness and deformity over the little finger knuckle and is classic for a punched injury.

This differs from other common wrist and hand fractures: a Colles fracture involves the distal radius after falling on an outstretched hand; a Smith fracture is a distal radius fracture with palmar displacement; and a Bennett fracture is an intra-articular base fracture of the first metacarpal (thumb). The described scenario—fifth metacarpal neck fracture from a straight punch—fits Boxer's fracture.