Historically, complex metacarpophalangeal (MCP) joint dislocations have necessitated open surgical management by either a volar or dorsal approach. The authors describe a relatively simple and reliable percutaneous technique to treat these complex MCP dislocations, with results comparable with open surgical reduction. This minimally invasive technique can be performed in the emergency room setting, thereby avoiding the cost and morbidity associated with an open procedure in the operating room. From 1996 to 2003, the percutaneous technique was performed on 4 patients with complex MCP joint dislocations. Three patients underwent percutaneous reduction in an operating room whereas the fourth patient was reduced in the emergency room. Successful reduction was attained on the first attempt in all 4 patients without complications. All dislocations were stable after reduction. Near full, painless range of motion was achieved in all 4 patients and there were no cases of recurrent instability. All patients were satisfied with their results.