Avascular necrosis of the metacarpal head is a rare disease. We herein report a case with varying degrees of lesions in the third and fourth metacarpal heads of the right hand and the third metacarpal head of the left hand. The patient was a 37-year-old male right-handed mechanical worker who presented with persistent dull pain in the right hand after labor work for more than a year. The 3 lesions in this patient were treated differently based on their clinical imaging manifestations. The neurologic function of the right hand recovered by the 18-month follow-up; only a slight limitation remained in the right middle finger. This is the first report of 1 patent who received 2 different treatment methods simultaneously and both provided a satisfactory clinical result.