One hundred fifty-eight patients with displaced fifth metacarpal neck fractures were treated with either K-wire pinning (KP; n=60), intramedullary pinning (IP; n=50), or combined intramedullary pinning with K-wire pinning (IPKP; n=48). The primary outcome was radiological correction (angulation and shortening). Secondary outcomes included range of motion (TAM), Quick-DASH scores, cosmetic scores, and complication rates. Outcomes were assessed preoperatively, postoperatively, and at 1-year follow-up. Overall, the study found that IPKP achieved significantly better angulation, less shortening, and higher cosmetic scores. Functional outcomes were similar, though stiffness occurred only in the KP and IP groups. These findings suggest that IPKP provides more accurate reduction, improved cosmesis, and fewer complications compared with conventional fixation methods.