Abstract Background Injuries to the second to fifth carpometacarpal joints in the hand are uncommon. They comprise less than 1% of all hand and wrist injuries. This injury may be missed when associated with long bone injuries Generalized swelling may obscure the characteristic deformity and routine radiographs may not show the displacement clearly. Neglected injuries lead to muscle imbalance / weakness, articular incongruity and arthritis. Diagnosis of this unusual for of injury requires a high index of suspicion, careful examination and true lateral radiograph of the hand and wrist. Patients and Methods 12 patients with carpometacrpal fracture dislocation were treated over 31 months at Zagazig University hospitals and Health insurance hospital. The mean age at time of injury was 29 years (range, 20 – 48 years). Nine patients were males and 3 patients were females. Six cases had motor-cycle accident, 2 cases had motor vehicle accidents, 3 cases fell on the hand, and in one case the mechanism of injury was punching. The dominant hand was involved in 9 cases. Open reduction and internal fixation by K-wires. was done in all 12 patients. The diagnosis had been missed in six patients when they first presented at an accident and emergency department; the delay in diagnosis was from three to eight days. Clinical and radiographic evaluation for all patients included postero-anterior, oblique and true lateral radiographs of wrist and hand. Results Mayo modified wrist score was used for clinical evaluation of all patients, which includes four domains: pain, job, range of motion and grip strength. The score is calculated from 0 to 100 points, with 91 to 100 points indicating an excellent outcome, 80 to 90 points a good outcome, 65 to 79 points a fair outcome, and < 64 points a poor outcome. According to Mayo modified wrist scoring system, eight patients (66.7%) showed excellent results, one patient (8.3%) presented with good result, and three (25 %) with fair results. Conclusion Carpometacarpal dislocation can be initially missed. Routine postero-anterior and oblique radiographs may not show the displacement clearly. A true lateral radiograph of the hand should be recommended for diagnosis of carpometacarpal dislocation. Open anatomical reduction and internal fixation with K-wires and early mobilization are required to achieve a good and early functional outcome.