Background <p>The second-to-fourth digit ratio (2D:4D) has been proposed as a morphometric marker of prenatal androgen exposure and has been linked to cognitive and behavioral traits. This study aimed to investigate the relationship between the 2D:4D ratio, fine hand motor skills, and practical anatomy examination performance among first-year medical students.</p> Methods <p>This cross-sectional study included voluntary first-year medical students at Kocaeli University Faculty of Medicine. The lengths of the second (2D) and fourth (4D) fingers of the right hand were measured using a digital caliper, and the 2D:4D ratio was calculated. Fine hand motor performance was assessed using the Nine-Hole Peg Test (NHPT). Practical anatomy examination scores were used to determine practical examination performance. Students with an average score above 65 were classified as successful.</p> Results <p>Correlation analysis showed a weak but statistically significant negative association between NHPT duration and practical anatomy examination performance (<i>ρ</i> = -0.21, <i>p</i> = 0.043). Female students achieved significantly higher mean practical examination scores than males (<i>p</i> = 0.044). No significant correlation was found between the 2D:4D ratio and practical examination performance (<i>ρ</i> = 0.02, <i>p</i> = 0.854). Successful students completed the NHPT in significantly shorter time than their peers (<i>p</i> = 0.016).</p> Conclusion <p>Fine hand motor skills performance was significantly associated with practical examination success, whereas no significant association was observed between the 2D:4D ratio and examination performance. Future studies should further investigate the influence of sex, question type, way of flagging, and time constraints in anatomy practical examinations.</p>