{"pk":17815,"title":"Punch Injuries: Insights into Intentional Closed Fist Injuries","subtitle":null,"abstract":"Objectives: This study sought to investigate the patterns of injury resulting from a punch mechanism and to investigate the associated psychopathology present in patients with these injuries.\n\n\nMethods: Retrospective analysis of patients with hand radiographs ordered from the emergency department allowed for identification of patients with a punch mechanism. We recorded injury patterns and queried patients’ medical records for associated psychopathology.\n\n\nResults: 1,292 patients underwent hand radiographs during a one-year time period; 172 patients (13%) were radiographed following an intentional punch injury, identifying 76 fractures in 70 patients. Males contributed a greater proportion of patients presenting with punch injury when compared to females (80% vs. 20%). Males were more likely to sustain fracture from a punch mechanism (48% vs. 11%, OR 7 [95% CI 2.3-20.9]), but were less likely to have preexisting documented psychiatric disease (23% vs. 49%, OR 3.1 [95% CI 1.4-6.7]). Of all fractures, 61% were to the fifth metacarpal, 21% were to the remainder of the metacarpals, and the remaining were fractures to phalanges and bones of the wrist.\n\n\nConclusion: Women are less likely to present with punch injury and are less likely to sustain a fracture when they do present but have more associated psychiatric disease. Both men and women presenting with punch injuries have a higher prevalence of psychiatric disease than the background incidence in the population as a whole. Although punch injuries result in a significant number of boxer fractures, a number of other injuries are associated with punch mechanisms. [West J Emerg Med. 2011;12(1):6-10.]","language":"en","license":{"name":"Creative Commons Attribution-NonCommercial  4.0","short_name":"CC BY-NC 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNonCommercial — You may not use the material for commercial purposes.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by-nc/4.0"},"keywords":[{"word":"Boxer's fracture"},{"word":"non-accidental trauma"},{"word":"psychiatric disease"},{"word":"Emergency Medicine"},{"word":"Mental and Social Health Services and Allied Professions"},{"word":"Surgery"}],"section":"Clinical Practice","is_remote":true,"remote_url":"https://escholarship.org/uc/item/53w1t9g9","frozenauthors":[{"first_name":"Rebecca","middle_name":"K.","last_name":"Jeanmonod","name_suffix":"","institution":"St. Luke’s Hospital and Health Network, Bethlehem, PA","department":"None"},{"first_name":"Donald","middle_name":"","last_name":"Jeanmonod MD","name_suffix":"","institution":"St. Luke’s Hospital and Health Network, Bethlehem, PA","department":"None"},{"first_name":"Sara","middle_name":"","last_name":"Damewood","name_suffix":"","institution":"John’s Hopkins University, Baltimore, MD","department":"None"},{"first_name":"Cheryl","middle_name":"","last_name":"Perry","name_suffix":"","institution":"Cape Fear Valley Medical Center, Fayetteville, NC","department":"None"},{"first_name":"Marwan","middle_name":"","last_name":"Powers","name_suffix":"","institution":"Cape Fear Valley Medical Center, Fayetteville, NC","department":"None"},{"first_name":"Vicky","middle_name":"","last_name":"Lazansky","name_suffix":"","institution":"St. Luke’s Hospital and Health Network, Bethlehem, PA","department":"None"}],"date_submitted":"2010-07-05T07:00:00Z","date_accepted":"2010-07-05T07:00:00Z","date_published":"2011-03-23T07:00:00Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/17815/galley/9097/download/"}]}