The purpose of the current study was to assess the outcome of antegrade intramedullary fixation with titanium elastic nail (TEN) in displaced fifth metacarpal neck fractures. The present study included 69 consecutive juvenile patients with displaced fifth metacarpal fractures. The head‑shaft angle of the fifth metacarpal and range of motion (ROM) of the metacarpophalangeal (MCP) joint were evaluated. A disabilities of the arm, shoulder and hand (DASH) questionnaire was used to assess upper arm function. The head‑shaft angle of the affected side was significantly improved postoperatively (P< 0.05). No marked difference was observed between the affected and unaffected side in head‑shaft angle and ROM. The average DASH score was 1.7 (range, 0‑6.0). All patients obtained anatomical reduction postoperatively and the average healing time was 5.7±1.09 weeks (range, 5‑10 weeks) with no non‑union cases. Therefore antegrade intramedullary fixation with TEN is recommended as an easy, reliable and minimally invasive surgical technique for treating displaced fifth metacarpal neck fractures.