Introduction: Headless compression screw fixation of hand and wrist fractures is an increasingly popular modality of osteosynthesis, although one limitation is difficulty in prosthesis removal. Case: A 27 year old male right handed carpenter presented to hand clinic with a displaced right 5th metacarpal shaft refracture 3 days after punch injury, in the setting of headless screw fixation of the same bone 7 months prior. Revision ORIF was performed- Screw removal first attempted by simultaneously twisting the screwdriver and screw head, as well as the screw shaft: however was unsuccessful due to poor purchase. Decision was made to cut the screw shaft, with both proximal and distal ends of the screw being manually twisted out. Redo headless screw fixation attempted and aborted due to poor stability. Compression plate fixation was completed successfully. Postoperative early active motion regime was undertaken without complication, demonstrating good ROM and improved clinical position. Discussion and conclusions: Warrender et al described one approach to bent headless screw removal (being only required in 1 out of 160 headless screw fixations in a multicentre series), advising for cannulation of the screw head with simultaneous twisting of the screw shaft through the fracture site. Although attempted, this did not work in our case due to an inability to adequately purchase the screw head with the screwdriver. Headless compression screw fixation has an established role in hand and wrist fracture management, however patient selection is crucial