To evaluate the clinical results between conservative and operative treatments and to give guidelines in the treatment of angulated fifth metacarpal neck fracture.

The 43 cases of fifth metacarpal neck fracture (25 operative cases, 18 conservative case) were reviewed. The functional and radiologic results between two groups were evaluated.

Both the operative group (preop.: 41.9 degree) and the conservative group (preop.: 39.7degree)showed satisfactory results (operative group: 15.3 degree, conservative group: 24.1degree) immediately after the correction. The maintenance of angulation correction was superior in operative group (15.7degree) than in conservative group (34.2degree), and patients' subjective satisfactions were superior in operative group too. Depressed knuckle on dorsum of hand was more frequently observed in conservative group (38.9%) than operative group (4%). Functional result in both groups was good.

Because the correction of angulation was not maintained well in conservative group and a large portion of complications often occurred in cases of angulation more than 40 degree, operative treatment is needed in cases of angulation of fractured site more than 40 degree in the fifth metacarpal neck fracture.