This patient struck a heavy object with his fist. He presented with swelling and tenderness on the dorsal aspect of his wrist. The PA radiograph shows the bases of the 4th and 5th metacarpals overlapping the hamate. The lateral radiograph shows the 5th metacarpal dislocated from its articulation with the hamate bone.

These injuries are usually managed with closed reduction followed by immobilization in an ulnar gutter splint. They should be seen by an orthopedic surgeon or hand specialist for follow-up.