The avascular necrosis of the metacarpal head is a rare disease. Therefore, although a variety of surgical treatments were performed in the sporadically published case reports, the optimal surgical treatment is still controversial. Open wedge osteotomy of the metacarpal neck was first reported in 2002. However, no other reports using the same procedure have been published. We presented 13-year-old girl case of the third metacarpal head necrosis having been treated by the open wedge osteotomy of the metacarpal neck. Four years later, she had no pain and gained full range of motion of the metacarpophalangeal (MP) joint. The plain X-rays and magnetic resonance images demonstrated sufficient bone remodeling of the metacarpal head. The open wedge osteotomy of the metacarpal neck is a useful option for the metacarpal head necrosis, especially when the dorsal articular surface of the head remains intact.