Abstract
Background
Isolated fractures of the distal fourth or fifth metacarpal bones, known as boxer's fractures (BF), are the most common type of metacarpal fracture. Boxer's fractures received their name from one of their most common causes — punching an object with a closed fist. This injury has been described as “a tolerable fracture in an intolerable patient” (1) It occurs commonly during fistfights or from punching a hard object such as a wall. Greer and William demonstrated that it is usually an intentional injury and these patients were at increased risk for recurrent injury (2). Further work suggested that patients with such injuries had higher features of antisocial, self-defeating personality disorders, self harm and impulsive behaviour, compared with control groups (3). It has been suggested that all patients presenting with such an injury should have psychiatric assessment.
The majority of studies in the literature have concentrated on adults and little has been reported on children and adolescents who present with such fractures.
This study aims to assess aggression scores in young patients discharged with metacarpal fractures due to punching using a validated questionnaire and this abstract presents the interim analysis.
Methodology
Following ethical permissions patients between 11 and 18 years of age, discharged with a metacarpal fracture caused by punching diagnosis codes S622, S623 or S624 and willing to complete an anonymous quetionnairre were included. All patients recieved an information sheet and for young people under 16 parental permission was sought.
The Bus and Warren validated questionnaire was completed by post, in person or over the telephone. The questionnaire included subscales of physical aggression and anger scales as well as overall aggression scoring and patients were asked to complete all sections.
Results
Twenty one patients who had metacarpal fractures due to punching have
completed the study to date. All were males aged between the age of 11 and 18. The physical aggression scores ranged from 13-39 with a mean of 27.5, median 31 and mode 33. Fifteen patients demonstrated high aggression scores. Six patients demonstrated average scores. Anger scores ranged from 7-31. Median 18.5, mode 13, median 20. Thirteen patients had high anger scores compared with their peers. Eight patients were within the average range. Overall aggression scores ranged from 66-133 with a mean of 100 and median of 100. Eleven patients demonstrated high scores and 5 were in the high average range.
Discussion/Conclusions
The initial interim results of this study show that over half the patients had higher overall aggression levels than the normal population
The physical aggression subscale focussed on the use of physical force and 71% had high physical aggression levels. High scores in this subscale indicate a lack of ability to control urges toward physical aggression and this is often seen in children with attention deficit disorder.
Anger scores may indicate a number of conduct disorders or abusive situations and in this study 62% had raised anger scores. This may be relevant in assessing children with punch injuries as they may benefit from assessment by the CAMS team for investigation and management of their anger and aggression issues which in turn may reduce recurrence of the injuries.
