The current issue of Essential Surgical Techniques from JBJS (Am) have an excellent article on the surgical treatment of 5th metacarpal fractures. Even though the majority of these fractures can be managed without surgery, there are those which are too displaced or angulated. If there is significant shortening or angulation the long term consequences for the patient may be minimised with the use of this less invasive technique of intramedullary pinning. This technique is practiced widely by Hand Surgeons in Sydney with similar good results, so this article offers our Trainee Surgeons a step-by-step guide to follow our operation.