An uncommon complex fracture-dislocation of the fifth metacarpophalangeal joint with an unusually important fracture component is presented. The injury was successfully treated by a combination of open reduction exposing the entrapping structures and percutaneous pin fixation. The case demonstrated the classic pathomechanics as described by Kaplan in 1957. The widened joint space and interposed sesamoid as described by Nutter in 1940 were seen on radiographs.