Background: In metacarpal fractures of the hand, intramedullary screw fixation (IMS) has been recognized as an alternate treatment option.  Objective: This study aimed to compare hand function restoration and pain reduction at postoperative follow-up between intramedullary versus K-wire fixation. Patients and Methods: 18 consecutive patients presented by a total of 20 metacarpal fractures were managed by two methods of surgical fixation; percutaneous pinning (PCP), and intramedullary headless compression screws (IMHS). They were followed up for a mean period of 12-24 weeks with an average period of 18 weeks. The study was conducted at Orthopedic Departments, Zagazig University Hospital (ZUH), and Alkhadra Hospital Tripoli (Libya). Results: Follow up (months), duration physiotherapy (weeks) and period to return work (days) were significantly shorter in IMHS group. Also, the same group significantly associated with no splint. Favorable outcome was associated more with IMHS group but non-significant (may be due to low number of study groups).  Conclusion: It's possible to safely and efficiently treat metacarpal fractures with intramedullary screw fixation because of its reduced risk of complications and superior prognosis after surgery. The screws required less casting and allowed workers to return to work more quickly than previously.