4 studies (3 quasi-randomized trials and 1 randomized controlled trial) comparing antegrade intramedullary nailing (AIMN) with other surgical interventions for fifth metacarpal neck fractures were included in this review to compare treatment efficacy. Pooled data demonstrated trends favouring AIMN for pain scores, the incidence of complications and mean residual angulation at the site of fracture. Additionally, AIMN yielded significantly greater grip strength at 12 months and improved range of motion of the metacarpophalangeal joint. When compared to transverse pinning (TP) with K-wires, AIMN yielded significantly better total active motion and greater patient satisfaction.