Background: Metacarpal fractures represent about 1/3 of hand fracture, which represent 10% of all fractures, mostly in the second and third decades of life. The purpose of this study was to evaluate the functional, radiological outcomes and reducing rate of complications in patients suffering of metacarpal fractures, treated by closed reduction and internal fixation by using headless compression screws. Patients and methods: This prospective one-arm clinical trial included 18 patients presented by a total of 20 metacarpal shaft fractures, who were managed surgically at Zagazig University Hospital (ZUH), Egypt. They were managed by intra medullary headless compression screws (IMHS). Results: No cases had malunion and 3 cases had superficial skin infection by 16.6%. Regarding Total Active Motion (TAM) score, 83.4% of cases had satisfactory level, and 16.6% had unsatisfactory level. Conclusion: Intramedullary screw fixation of metacarpal fractures is an efficient and safe procedure with a low incidence of complications. The IMH screws appeared to require less casting and provide a quicker return to work.