Osteonecrosis of the metacarpal head is a rare disease entity and there are only a few isolated case reports in the literature. No single modality of treatment can be recommended as ideal. In this report, we describe a patient who presented with changes resembling avascular necrosis at the third metacarpal head of the right hand. It presented as a 2-week history of sudden onset of pain in the region of the right third metacarpophalangeal joint with limitation of flexion. We treated the 51-year-old male patient by curettage, debridement and multiple drilling. At 1-year follow-up, the patient was symptom-free and showed improved range of motion of the metacarpophalangeal joint (0 to 80 degrees). He returned to his original work 2 weeks after the operation without limitation of daily activities. This report presents a new operative treatment that improved the functional outcome of osteonecrosis of the metacarpal head.