Comminuted intra-articular fractures are among the most difficult to fix, with open reduction and internal fixation often being impossible. We report the case of a 15-year-old male who required an open reduction with external fixation after sustaining an extremely comminuted intra-articular fifth metacarpal head fracture of the right hand. The patient presented with swelling localised to the fourth and fifth dorsal metacarpals of the right hand, with radiographs demonstrating an intra-articular fracture with comminution and articular surface depression. Literature surrounding metacarpal head fractures, although scarce, suggests that whilst treatment must be individualised, most osteochondral fractures can be managed via open reduction with internal fixation either via K wires, interfragmentary screws or small headless screws. This case demonstrates that in challenging cases, with limited bone stock and cavities created through reduction of the fracture, fixation can be achieved through K wire with HK2 external fixation. It also highlights the apparent insufficiency in articles specifically detailing potential management options for intra-articular metacarpal fractures and has provided evidence of one potential fixation method.