Metacarpal fractures are one of the most common injuries of the upper extremity. Physical examination and the correct imaging are the keys for proper management. Treatment includes conservative or surgical methods due to the fractured metacarpal, the grade e.i., shortening, angulation and rotation of the fracture. In surgical treatment there are lots of options and major issue is the geometry of the fracture. Excessive immobilization should be avoided to prevent stiffness in fingers. More than 2 mm of intra-articular displacement should be corrected. In case of segmental bone loss, generally severe soft tissue defects are encountered and the height of the metacarpal should be maintained as initial management. The diagnoses of ulnar carpometacarpal fracture dislocations are challenging. Oblique radiographs and computerized tomography are useful in diagnosis.

Thumb metacarpal shaft fractures are treated similarly as the other metacarpals. On the other hand, intra-articular basis fractures including thumb metacarpal are likely to displace and more attention should be paid to prevent posttraumatic arthritis. If the physician treating metacarpal fracture knows the options in treatment and the risks and benefits of them, low rate of complications could be achieved.