A, Radiograph of hand of 20-year-old man who sustained horizontally directed fracture of fourth metacarpal head with palmar fragment displaced proximally. B, Fracture was reduced and held in place with Kirschner wires. C, At 4 months, radiographs showed early osteonecrosis of metacarpal head. D, At 2½ years, radiographs showed some remodeling but definite incongruities of metacarpal head.