Patients with intentional punch injuries in the emergency department: a retrospective cohort study.

Purpose: Hand and wrist injuries represent some of the most common traumatic conditions encountered in the emergency department (ED). Our study aimed to elucidate the demographic and clinical characteristics of patients sustaining intentional punch injuries.

Methods: This single-center retrospective study involved patients aged 16 years and older who presented to the ED with intentional punch injuries in 2023.

Results: A total of 405 patients were included in the study. The median patient age was 30 years (interquartile range, 22-40 years), and 363 (89.6%) were male. Among the patients, a total of 389 fractures were identified in 362 patients (89.4%). Metacarpal bone fractures were the most common, with 372 fractures (95.6%). The fifth metacarpal was the most frequently injured (67.4%), followed by the fourth (10.0%) and third (7.7%) metacarpals. Although the most common base fracture occurred in the first metacarpal, shaft fractures were most prevalent in the second, third, fourth, and fifth metacarpals. Overall, 259 patients (71.5%) had nondisplaced fractures. Additionally, 31 patients (7.7%) had previously been admitted to the ED for punching, 17 (4.2%) had prior ED visits for trauma resulting in a fracture, and 63 (15.6%) reported a history of psychiatric drug use.

Conclusions: Young men represent the majority of intentional punch injury patients. The fifth metacarpal and its shaft fractures were most commonly observed. A history of prior ED visits for punching or trauma, as well as psychiatric medication use, may serve as potential risk factors.