Intra-articular metacarpal head fracture is relatively rare. We report a case of coronal intra-articular and epiphyseal fractures of Salter-Harris type IV injury in the metacarpal head of the index finger. Surgery was performed by a dorsal approach. The volar fragment that was displaced proximally was gently reduced while bending the metacarpophalangeal (MP) joint, and it was fixed with cortical screws inserted proximal to the articular cartilage facilitating early rehabilitation. We consider the mechanism of injury to be a force applied from the distal phalanx that was transmitted unevenly to the volar side when the MP joint was slightly flexed. A three-dimensional computed tomography scan was useful in making the precise diagnosis, confirming the fracture pattern and planning fixation of the fracture.
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