Twenty-three patients with dislocated intrarticular fractures of the base of the fifth metacarpal were treated during the last 3 years in our department. This fracture characteristically occurs in young, active males, and the most frequent mechanism of this injury is axial force striking the metacarpal head, mostly in fist fights. In 8 patients, the fracture was caused by direct force hitting the base of the fifth metacarpal. Four certain fracture patterns are described. Operative treatment by open reduction and fixation with two Kirschner wires generally gave good results.