The hand x-ray shows an intra-articular two part fracture of the base of the 5th metacarpal. This pattern of injury is called the ‘Reverse Bennett’s Fracture’, and is analogous to the Bennett’s fracture of the base of the thumb metacarpal.

This is an unstable injury; the pull of extensor carpi ulnaris, which inserts at the base of the fifth metacarpal, acts as a deforming force, and as such, this fracture needs a referral to a hand surgeon for consideration of operative management.