46 adult male patients with displaced fifth metacarpal neck fractures were included in the study. Patients were randomized to undergo surgery with either an antegrade intramedullary pinning technique or a retrograde intramedullary pinning technique to compare several clinical and radiographic outcomes between these procedures. The study found that while the antegrade approach yielded significantly improved clinical outcomes (range of motion (ROM), visual analogue scale (VAS) pain score, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score) 3 months post-surgery, the difference was not maintained at 6 months post-surgery. Radiographic outcomes, including shortening and angulation, were also comparable between the groups 6 months post-surgery.