In this study, we review the incidence and aetiology of 3858 metacarpal fractures in a series of 235,427 patients across the life-span. We found men aged 10-29 to have the highest incidence rates for metacarpal fracture (2.5 per cent). Accidental fall was the dominant cause of these fractures in the age group 9 years or less (38.7 per cent) and in the groups 50 years and older. Our data clearly show transport accidents and in particular bicycle accidents to be major determinants in all age groups. We conclude that recognition of the high frequency of metacarpal fractures among men aged 10-29 years should be given and public expenditure should be invested in the development and recommendation of proper safety gear.