It is estimated that hand injuries account for over 20% of all emergency department presentations in Australia and that metacarpal fractures constitute 1 in 5 upper extremity fractures. With the majority of metacarpal injuries affecting 15-35yrs it also carries a huge economic burden. Surprisingly though, even with such a high incidence there is limited guidelines for surgeons when deciding between operative and conservative treatment and percutaneous K-wiring and open reduction internal fixation. The majority of surgeons rely on both radiological findings (angulation, shortening, articular involvement etc) and clinical findings (malrotation, open fractures, multiple metacarpal fractures) when deciding between types of surgical fixation. On one hand, inserting Kirschner wires is fast, minimally invasive and comparatively cheap. While on the other it doesn’t provide stable fixation, potential for pin-track infections and they have the potential to migrate. Our literature review aims to review the current high level evidence of metacarpal fixation in single shaft fractures.