Metacarpal fractures are common, especially in men, and account for about 10% of all fractures in patients. The fracture pattern and location, and the degree of angulation are important in determining the optimal treatment approach. Although metacarpal fractures can be treated nonsurgically, certain indications such as irreducible fractures, malrotations, and open fractures may necessitate surgery. Intramedullary nail fixation has been successful in treating metacarpal fractures. Complications can be minimized by taking appropriate precautions and care in performing the surgery.