5th Metacarpal Fracture (a.k.a. Boxer's Fracture) Recovery and Rehab

Disclaimer: I am not a doctor.  This is not medical advice.  

I am sharing my n=1 story to hopefully help other climbers that have a similar injury get back to climbing, as quickly as possible.  

Injury
I suffered a mid-shaft spiral fracture of my 5th metacarpal.  Bone displacement was about 4mm.  


Treatment
I opted not to have surgery.  I had a cast that immobilized my wrist, pinky, and ring finger for 8 weeks.  

In my particular case, the doctors that I consulted with did not know much about climbing.  The doctor recommended that I avoid climbing on the injured hand, until 4 months after the injury.  I decided instead to use my pain response to determine when it would be safe for me to start climbing again.

i progressively loaded my injured hand, until i could hold half my weight without inducing a pain response.  I then started top roping easy routes in the gym, in my cast, three weeks after the injury occurred.  The cast limited my ability to use certain holds.  

In retrospect, I should have asked the doctor & casting technician to make non-standard alterations to my cast.   To maximize your ability to climb in the cast, I recommend doing the following:

1. Ensure the fingers are oriented upwards, rather than flexed forward, when the cast is being applied.  By default, the casting technician will likely try to flex your fingers to a position that is roughly in the middle of your range of motion.   
2. Ensure that your hand is approximately inline with your forearm, when the cast is being applied.  In my case, the hand was cocked back, which may be the default position.

Rehab
My cast was removed after 8 weeks.  I was able to climb easy routes in the gym, on the same day that the cast was removed.  It took about 5 days to regain full range of motion.  When my using my fingers in a position near the middle of my range of motion, my strength was roughly 70% of my pre-injury strength.  After about 3 weeks of rehab, my strength is about 90% of my pre-injury strength.  I suspect that my starting strength would have been significantly lower and my rehab duration would have been significantly longer, if I had not been climbing in my cast.  

Conclusions

1. It may be possible to safely climb, while the broken bone is in a cast and has not completely healed, as long as the loads are sufficiently low to avoid inducing a pain response.  
2. During the casting process, changing the angle of inclination of the immobilized wrist and fingers may affect the degree to which your free fingers will be able to reach and grasp holds.
3. Climbing in a cast likely results in isometric strength training of the immobilized fingers, thereby reducing muscle atrophy, during immobilization.  This may result in higher strength upon removal of the cast and a shorter rehabilitation period.  

The wrist is cocked back like that in a cast because grip is stronger in that position. Make a firm fist with your newly freed wrist straight and then wrist cocked back and you will see what I mean.
As such it might not be a good idea to be casted straight.
I also am not a doctor. 

Jon Rhoderick wrote: The wrist is cocked back like that in a cast because grip is stronger in that position. Make a firm fist with your newly freed wrist straight and then wrist cocked back and you will see what I mean.
As such it might not be a good idea to be casted straight.
I also am not a doctor. 

You are correct.  Perhaps a slight cocking of the wrist would be optimal.  

My issue with the wrist being cocked back "too far" is that it is harder to reach and grasp holds.  If you cannot reach and grasp a hold with your free fingers, because your immobilized wrist or immobilized fingers get in the way, strength doesn't matter.  There were a lot of holds that I could not grasp, simply due to the geometry of the cast.  

 Needed surgery on mine. Cast comes off 1/22. I hope I have a quick recovery like you

Just a heads the fingers are placed at 70 degrees flexion to avoid tightening of the collateral ligaments. Never want to cast the digits in extension at the MCP because your collateral ligaments will become tight and result in difficulty getting motion back. If you are dedicated to stretching after your 4-6 weeks (or 8 depending on injury) of immobilization then feel free to cast yourself in extension. 

My 3 pieces of wisdom regarding broken bones:

• AVOID SURGERY if there is a realistic choice.  Numerous doctors have told me this too.  Of course this is very injury specific.  I'm currently still rehabbing from my first surgical experience.  (See the bottom of this thread for pictures and injury reports)
• Don't be TOO TOUGH.  Several times it has taken me hours, days, weeks before I realised that this injury could be a break.  This could have life time repercussions.  One of my toes will never be the same as kept highly active on it for over a month.  (Still broken a month later when I got x-rays.)
• In contradiction to the previous.  Do be tough during rehab.  I think most climbers don't have a problem with this.  Of course let pain be your guide, but the average physio seems to spend half their time pushing their patients beyond their pain comfort zone.  Most climbers are used to that.

The doctor recommended that I avoid climbing on the injured hand, until 4 months after the injury.  I decided instead to use my pain response to determine when it would be safe for me to start climbing again.

Good choice.  In general, let doctors guide you on the skeletal part of the recovery.  Which should only be 3-6 depending on the break.  Either self guide via pain feedback or let a physio guid the rehab section.

That said every injury and break is different.  And so listen to the experts and your own body.  In my fastest recovery I broke a couple of ribs and overseas climbing withing 4 weeks!  In my most recent injury I've now spent 6.5 weeks non weight bearing and about the same period in weight bearing rehab.  Sure I probably could have cut that 6.5 week at least 1.5weeks shorter, but is it worth the risk?  In rehab now supposedly for 6 months, but I'm going to try to make that 3months.

(For me this time getting back climbing has been low priority for me.  Walking easily and then running easily are my goals.  Climbing is low priority.  But when I did try the climbing gym I found it far less challenging than I expected.  Slab climbs and approaches are the bigger challenges.)

Karl - 

how did you sustain the injury? Just found out today i fractured my 3rd metatarsal. Did it while climbing. Awkwardly grabbing an undercling and it popped. Thought I snapped a pulley for sure but turns out, the noise was my bone breaking. No surgery for me, luckily. Thanks for the insight. 

Torrence Groen wrote:

Karl - 

how did you sustain the injury? Just found out today i fractured my 3rd metatarsal. Did it while climbing. Awkwardly grabbing an undercling and it popped. Thought I snapped a pulley for sure but turns out, the noise was my bone breaking. No surgery for me, luckily. Thanks for the insight. 

I slipped on any icy talus field and put my hand out to catch the fall.  My hand crumpled awkwardly against the talus.  I wasn’t sure that I had broken a bone, until I took x-rays.  

My fifth is fractured right now (happened last Saturday), with some angulation and slight scissoring. Thanks for posting your story. My doctor said he doesn't expect any significant loss of strength and that surgery shouldn't be needed. We didnt do a closed reduction because there were already signs of healing. I'm currently in an adjustable brace just to protect the bone, and my hangboard just keeps whispering "You have 2-3 good fingers still...." Now my home wall is calling to me, too.

Edit: And I just realized I responded to a really old post. Oops!

nullnull the same fraction. 6week cast and still continue(probably 2w more) had a cast off while x rays and little finger was pretty stiff. Desperate to be back again..

nullnull the same fraction. 6week cast and still continue(probably 2w more) had a cast off while x rays and little finger was pretty stiff. Desperate to be back again..

wow you guys are unlucky, never hear of anybody outside of my old boxing gyms getting that injury. we had a bit of an atypical rehab process with a lot of wrist rotation exercises to rebuild the forearm muscles while we were waiting to be able to punch at full strength. Our coach was also a major proponent of continuing to train with one hand, apparently there's research indicating less atrophy of the injured limb when continuing to train the other. Also don't be afraid to wrap something around your cast at the wrist to be able to continue (or begin) lifting weights if it doesn't cause pain. Might as well keep everything else strong.