The anatomy, pathology, and etiology of knuckle fracture have been presented, with a case of malunion successfully treated by a simple operation. The procedure outlined and carried out on the case presented has the advantage of early motion, attacks the seat of the pathology, does away with the bony prominences, diminishes the anteroposterior and transverse diameters of the metacarpal bone, and reestablishes a more normal relationship with the flexor and extensor tendons. The change in the axis of a malunited knuckle fracture is not corrected by this operation, but this distortion may be more than compensated by the motion normally present in the third, fourth, and fifth carpometacarpal joints.

In malunited knuckle fracture, the space between the extensor tendon and synovial roof may be obliterated by fibrous tissue which limits flexion of the finger and impairs function of the hand. In such a case osteotomy, usually done above the site of the pathology, is of little avail, and may only raise the metacarpal head. Arthroplasty with resection of the normally aligned and intact articular surfaces seems contra-indicated. Certainly, in the author's experience, the ends do not justify the means.