Arthroscopy of the first carpometacarpal (CMC) joint has become routine. Similar techniques can be applied to fracture dislocations involving the fifth CMC joint. This situation is one whereby arthroscopy is definitely of benefit, because the articular fracture fragment is often volar, and difficult to visualize and reduce from a dorsal approach. This article describes arthroscopic techniques for reduction and percutaneous fixation of fifth CMC fracture dislocations.