We report the case of a 58-year-old man who sustained an open palmar dislocation of the fifth metacarpophalangeal joint of the little finger secondary to a bicycle accident with an uncommon presentation. These open dislocations have only been reported once in the literature. A palmar and dorsal approach had to be used to completely free the joint from incarcerations and allow complete reduction and repair of the damaged anatomical structures. We then discuss this particular type of dislocation, its pathophysiology and management.