A complex fracture-dislocation involving the fifth metacarpophalangeal (MCP) joint occurred in a 16-year-old boy approaching skeletal maturity. Roentgenographic examination demonstrated a widened MCP joint and a dorsally displaced Salter-Harris Type III fracture of the metacarpal head. Attempted manipulative closed reduction was unsuccessful. To achieve successful reduction and fixation it was necessary to make a dorsal approach, incise the interposed volar plate longitudinally, and lever it to the anatomic volar position. Successful fixation of the fracture would have been impossible through a volar approach. The Salter-Harris Type III fracture is a surgical problem.