Metacarpal fractures are most often caused by direct violence, such as blows or crushing injuries, and can be single or multiple fractures of the metacarpal. Transverse and comminuted fractures are common, and oblique or spiral fractures can also occur due to torsion and indirect violence. Treatment requires both adequate immobilization and appropriate early activity, which is conducive to the recovery of hand function. Fracture of the base of the 1st metacarpal with dislocation, also known as Bennett’s fracture dislocation, is an extremely unstable fracture. When the 1st metacarpal bone is in a mildly flexed position and is subjected to an external force on the longitudinal axis, an intra-articular fracture is produced at the base of the 1st metacarpal bone with a fracture line that slopes from medial to inferior, forming a triangular-shaped block at the base of the medial metacarpal bone. This mass is generally smaller than 1/3 of the articular surface at the base and will continue to maintain its position in relation to the greater trochanter due to the attachment of the lateral collateral ligament of the metacarpal; the distal portion of the fracture, the first metacarpal, will be dislocated radially and dorsally as a result of the pull of the extensor hallucis longus muscle. This is a case of a fracture with dislocation that was treated surgically after conservative treatment failed. The principle of surgical treatment is that both adequate immobilization and early movement are necessary to facilitate the recovery of hand function. The uninjured finger should never be immobilized to ensure the movement of other fingers. The fracture must be correctly repositioned without angulation, rotation, or overlapping displacement. The tip of each finger points to the navicular tuberosity when it is flexed individually. If the finger is flexed after repositioning and the fingertip points to the radial or ulnar side of the navicular tuberosity, the fracture is rotated or laterally angulated, and must be corrected, otherwise the fracture will result in crossed fingers when making a fist after healing. For open fractures, the first step is to strive for one-stage healing of the wound, while paying attention to the correct restoration of the fracture. For fractures and dislocations of the metacarpal, phalanges and carpal bones, most of them are treated with closed reduction and external fixation. Indications for surgery: in cases of open fractures, dislocations and fracture dislocations, one-stage debridement and reduction, internal fixation and wound closure. Displaced, not readily reducible or unstable fractures with or without subluxation and dislocation of the articular surfaces; unstable diaphyseal fractures not readily reducible; complete avulsion fractures of the lateral collateral ligaments of the joints, resulting in joint instability, especially large pieces of the ligaments attaching to the articular surfaces or fracture fragments impinging on the articular surfaces; complete avulsions of the stopping points of the lateral collateral ligaments, resulting in joint instability, especially in the metacarpophalangeal joints of the thumbs, the metacarpal joints of the index finger Involvement of the radial aspect of the metacarpophalangeal joint of the thumb, the metacarpophalangeal joint of the index finger, and the proximal interphalangeal joint of the little finger; unstable dislocations or fracture dislocations that are not easily reset; internal fixation of a fracture while decompression is necessary to prevent ischemia, necrosis, and contracture of the intrinsic muscles of the hand in the event of closed injuries combined with compartmentalization of the hand; and separation of the epiphyseal plate that is not easily reset or is unstable. Separation of the epiphyseal plate. Postoperative films are as follows.