The annual incidence of metacarpal fractures has been reported to be 16.1 per 10,000 people. In the management of these injuries, two factors will aid decision-making, displacement and stability. If a metacarpal fracture is displaced, then one needs to ask whether this displacement will cause unacceptable deformity, unacceptable function or post traumatic arthritis. If the answer is yes, the fracture must be reduced whether by closed or open techniques. In this chapter reduction and fixations techniques are discussed of metacarpal injuries.