Back to 2026 ePosters
Wall vs. Jaw: Does What You Punch Determine What You Break?
Naem Anthony Mufarreh, DO
1, Alex Davis, DO
2, Michael R McDermott, DO
1, Natalie Bauer, MD
1; H Brent Bamberger, DO
3(1)Kettering Health Grandview, Dayton, OH, (2)Ohio University College of Osteopathic Medicine, Athens, OH, (3)Grandview Medical Center, Dayton, OH
Background: The mechanism of injury, such as punching a person versus a solid object, is thought to influence fracture patterns and the surgical fixation required for treatment. It is hypothesized that punching harder objects leads to more unstable fractures that necessitate more rigid fixation.
Methods: A retrospective review was conducted on patients who underwent surgical treatment for metacarpal and phalangeal fractures between January 2020 and December 2024. The injury mechanisms were divided into two categories: punching a solid object (e.g., walls or mailboxes) or punching a non-solid object (e.g., a person or a punching bag). Surgical fixation methods included percutaneous pinning, intramedullary (IM) fixation, plate fixation, and external fixation. Statistical analyses was performed to assess correlations between the injuries and fixation type.
Results: Of 528 patients who underwent surgery for hand fractures, 71 patients sustained punch-related injuries, resulting in 92 fractures. The average age of these patients was 32.0 ± 12.7 years. Most fractures (81.3%) resulted from punching a solid object, while 18.7% were from punching a non-solid object. The small finger was most commonly fractured after punching a solid object (66.2%), whereas the ring finger was more frequently fractured in non-solid object injuries (41.2%, p = 0.014). Metacarpal fractures were significantly more common in solid object injuries (97.3%) than in non-solid object injuries (70.6%, p < 0.001). Middle phalanx fractures, conversely, were more frequent in non-solid object injuries (17.6%) than in solid object injuries (1.4%, p < 0.001). Percutaneous pinning was the most common surgical fixation method (51.6%), followed by IM fixation (42.9%) and plate fixation (4.4%). IM fixation was achieved using intramedullary nails (51.3%) or headless compression screws (48.7%). The average operative time was 54.1 ± 21.6 minutes, with no significant difference between fixation types (p = 0.389). Despite the differences in fracture location based on the object punched, there was no significant correlation between the injury mechanism and the fixation method used (p = 0.178).
Conclusion: The findings indicate that the object punched significantly influences the location of hand fractures, with solid objects leading to more small finger and metacarpal fractures, while non-solid objects resulted in more ring finger and middle phalanx fractures. There was no significant correlation between the mechanism of injury and the chosen method of surgical fixation. These results suggest that while the object punched can determine the fracture pattern, it does not appear to correlate with the type of surgical fixation required.
Back to 2026 ePosters
