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The purposes of this study were to evaluate the efficacy of antegrade intramedullary pinning performed for neck fractures with angulations of over 30 degrees after failed conservative treatment during the subacute phase and to compare the radiologic and clinical results with those of acute fractures with angulations of over 30 degrees treated via the same procedure.Seventy-three patients with a fifth metacarpal neck fracture were admitted to our institute between January 2010 and April 2015. Among them, 26 patients with an acute fracture (group 1) and 27 patients with a subacute fracture after failed conservative treatment who met the inclusion/exclusion criteria were investigated. After surgery, improvements in angulation and shortening, visual analog scale score for postoperative pain, Disabilities of the Arm, Shoulder, and Hand score, active range of motion, and grip strength were evaluated and compared.The mean durations of surgery from injury were 4.92 and 32.74 days in groups 1 and 2, respectively, with a significant difference (P < 0.001). The preoperative amounts of angulation were 44.91 and 45.89 degrees, and the amounts of preoperative shortening were 3.31 and 3.44 mm, respectively, with no significant difference (P > 0.05). At the final follow-up, the angulation had definitively improved compared with before surgery in both groups (P < 0.001, both). However, there was a slight significant difference in terms of the residual angulation of 3.35 and 5.56 degrees in groups 1 and 2, respectively (P = 0.02). Preoperative shortening was restored in both groups (P < 0.001, both) and the final state of residual shortening were similar (P = 0.06). The final visual analog scale scores, Disabilities of the Arm, Shoulder, and Hand scores, range of motion, and grip strength were all satisfactory in both groups without any significant difference.The failed treatment group, which had been predicted to obtain proper union through the initial use of conservative treatment, provided an adequate indication for noninvasive antegrade pinning. In addition, the current study suggested that closed reduction/immobilization remains a primary recommendation for angulated metacarpal neck fracture as long as careful observation is conducted if progression of the reduced fracture toward dorsal angulation is suspected.