This retrospective analysis investigated the clinical effect of closed reduction and external fixation on unstable fractures at the base of the first metacarpal. A total of 23 patients with unstable fractures at the base of the first metacarpal were treated, including six with Bennett fractures, three with Rolando fractures, six with extra-articular transverse fractures, and eight with extra-articular oblique fractures. If closed reduction by all fracture manual reset techniques was satisfactory, external fixation was used. Postoperative fracture healing was assessed by X-ray imaging. In the 24-month follow-up period, functional recovery was assessed by, Disability of the Arm, Shoulder, and Hand (DASH), total active motion test of the thumb, Jamar dynamometer thumb muscle testing. The fracture healing time was 8-12 weeks. Nineteen cases were followed up for up to 24 months (82.6%). The average DASH score was 3.4 ± 0.8. The total active motion loss of the thumb was 7.5 ± 1.3°. The thumb grip strength of the affected side on Jamar dynamometer testing was 65.5-113% of the uninjured side, while the pinch strength of the affected side was 66.6-104.5% of the uninjured side. Patients with unstable fractures at the base of the first metacarpal treated with closed reduction and external fixation underwent 2 years of follow-up, which revealed good functional thumb recovery.