Among the digits, the thumb's anatomy is unique. Thumb fractures require special treatment considerations since inappropriate management can compromise pinch, grasp, and overall hand function. This article reviews the most common types of thumb phalangeal and metacarpal injuries. The literature is presented in the context of the latest operative treatment trends, techniques, and hardware. At the current time, there are numerous surgical techniques that can be used to manage various thumb fractures. However, few gold standards have been established, and the technique choice often is dictated by the surgeon's preferences and experience. In addition, currently available data on thumb injuries often are presented in the context of all finger injuries. Well-controlled comparative and biomechanical studies exclusive to thumb fracture treatment can ultimately establish treatment standards.