Ace the NBCOT Upper Extremity Test 2026 – Flex Your Skills and Score Big!

This question is about recognizing a Boxer's fracture, which is a fracture of the neck of the fifth metacarpal often caused by punching a hard object with a clenched fist. The mechanism explains why the fracture occurs at the metacarpal neck and why the little finger side can deform or appear sunken since the fracture alters the alignment of the fifth metacarpal with the hand. Clinically, you’d expect tenderness and swelling over the 5th metacarpal, and sometimes a depressed knuckle with possible rotational deformity. Management usually involves immobilization with the MCP joints flexed to about 60–90 degrees to preserve alignment and allow healing, often using an ulnar gutter or short-arm cast; surgery may be considered if there is significant displacement, angulation, rotation, or intra-articular involvement.

The other fractures mentioned refer to different parts of the forearm. A Smith’s fracture is a distal radius fracture with volar displacement, Colles fracture is a distal radius fracture with dorsal angulation, and a Monteggia fracture is a fracture of the proximal ulna with dislocation of the radial head.