Boxer's fracture refers to a displaced fracture of the small finger metacarpal neck, typically with palmar angulation (apex dorsal). These are usually not stable and often present late after injury. Considerable angulation may be tolerable because of compensation through the mobile small finger metacarpophalangeal joint and the small finger carpometacarpal joint. It is not possible to reliably secure and maintain reduction with a cast alone, although a number of authors have recommended this. Residual angulation will result in a cosmetic loss of dorsal prominence of the small finger metacarpal head and prominence of the metacarpal head in the palm, neither of which routinely justifies surgery. However, if the patient has more angulation than can be compensated for by their joint motion, extensor tendon imbalance will result and patient will develop a secondary flexion contracture of the proximal interphalangeal joint (Fig. 7). Reduction and fixation is indicated when the patient can not fully straighten their small finger proximal interphalangeal joint, rather than by a radiographic classification of the fracture itself. Percutaneous reduction may be achieved using longitudinal Kirschner wires driven from distal to proximal, or open reduction with tension band or plate and screw technique may be used. Open boxer's fractures should be suspected for possible clenched fist bite wound injury, discussed below.