85 patients with fifth metacarpal neck fractures and palmar angulation >30 deg were randomized to receive either conservative treatment (plaster-of-Paris cast and buddy strapping) or operative treatment through closed reduction and internal fixation by antegrade intramedullary bouquet pinning. This study aimed to determine if conservative treatment was non-inferior to operative treatment with respect to function, pain, satisfaction, and quality of life over 1 year following treatment. The results of this trial indicated that both treatment arms were equally effective. There were some significant differences noted between groups: the conservative group were more often discontent with the appearance of the injured hand; the operative group had a greater incidence of complications and longer period of disability.