This video describes a novel approach to surgical fixation of proximal and midshaft metacarpal fractures via antegrade placement of intramedullary headless compression screws. Retrograde placement of intramedullary screws has been described for the fixation of metacarpal neck and shaft fractures. This video showcases reduction of a simulated metacarpal shaft fracture via an osteotomy followed by guidewire placement (similar to a retrograde approach). The guidewire is passed proximally through the base of the metacarpal, missing the dorsal surface of the capitate, and out the dorsum of the wrist percutaneously. A small stab incision is made where the guidewire exits the carpometacarpal joint. An appropriate size cannulated drill is used in an antegrade direction over the guidewire, after which an appropriate size and length intramedullary headless compression screw is placed. Dissection and fluoroscopic images are provided to detail the surgical technique.