Abstract: A percutaneous metatarsal fixation guide, including methods of use, is provided. The percutaneous metatarsal fixation guide includes a means for aligning a drill guide bearing a drill sleeve with the central longitudinal axis of a fractured metatarsal, metacarpal, or similar bone. Precise radiographic alignment of the drill sleeve with the long axis of the fractured bone facilitates accurate placement of fixation hardware across the fracture site, allowing for healing in alignment. The fixation bearing two corresponding index wheels is rigidly mounted to a tarsal bone via a temporary threaded K-wire, wherein an index marking on a second index wheel coupled to a drill sleeve may be positioned to correspond with an index marking on first index wheel coupled to an alignment guide, such that the drill sleeve is aligned with the fractured metatarsal. This allows precise placement of fixation hardware, compared to using a conventional “free-hand” technique.