Injuries to the bases of the index finger and long finger metacarpals are unusual because of the stability of the carpometacarpal joints. Such stability is provided by the strong capsuloligamentous attachments and the unique bony architecture. Given the rare nature of these injuries, there is no consensus regarding the optimal management of avulsion fractures of the bases of the index finger and long finger metacarpals. Open reduction and internal fixation of the fracture, with anatomic repair of the extensor carpi radialis brevis or extensor carpi radialis longus, offers several advantages over closed treatment. A case report and a review of the literature are presented.